Provider Demographics
NPI:1366246746
Name:DIERINGER, SAMANTHA (RDH, OMT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:DIERINGER
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9381
Mailing Address - Country:US
Mailing Address - Phone:304-629-2118
Mailing Address - Fax:
Practice Address - Street 1:2017 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-6013
Practice Address - Country:US
Practice Address - Phone:304-623-9188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2972124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist