Healthcare Provider Details

I. General information

NPI: 1689379240
Provider Name (Legal Business Name): SAMANTHA PAIGE MANDEL KUBECK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA PAIGE MANDEL DDS

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S GETTY ST
MUSKEGON MI
49444-1207
US

IV. Provider business mailing address

3641 BRYCE DR
HUDSONVILLE MI
49426-8535
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-9315
  • Fax:
Mailing address:
  • Phone: 734-776-1047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601846
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: