Healthcare Provider Details

I. General information

NPI: 1558590851
Provider Name (Legal Business Name): CRISTEN MARIE SCHIPPAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTEN MARIE DIETZ DMD

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7551 FOREST OAKS BLVD
SPRING HILL FL
34606-2437
US

IV. Provider business mailing address

7614 RADCLIFFE CIR # B101
PORT RICHEY FL
34668-5963
US

V. Phone/Fax

Practice location:
  • Phone: 352-518-2000
  • Fax:
Mailing address:
  • Phone: 727-808-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDN18780
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN18780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: