Provider Demographics
NPI:1285749507
Name:CLOPP, MICHAEL RICHARD (DMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RICHARD
Last Name:CLOPP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20399 ROUTE 19 STE 110
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6138
Mailing Address - Country:US
Mailing Address - Phone:724-776-4088
Mailing Address - Fax:724-776-3955
Practice Address - Street 1:20399 ROUTE 19 STE 110
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6138
Practice Address - Country:US
Practice Address - Phone:724-776-4088
Practice Address - Fax:724-776-3955
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029785L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice