Provider Demographics
NPI:1558590851
Name:SCHIPPAN, CRISTEN MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:CRISTEN
Middle Name:MARIE
Last Name:SCHIPPAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CRISTEN
Other - Middle Name:MARIE
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7614 RADCLIFFE CIR # B101
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-5963
Mailing Address - Country:US
Mailing Address - Phone:727-808-9118
Mailing Address - Fax:
Practice Address - Street 1:7551 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2437
Practice Address - Country:US
Practice Address - Phone:352-518-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187801223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104301000Medicaid
FLDN18780OtherSTATE LICENSE