Provider Demographics
NPI:1003952649
Name:PIPHO, DONNA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:D
Last Name:PIPHO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HIGHWAY 218 NORTH PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651
Mailing Address - Country:US
Mailing Address - Phone:319-342-3622
Mailing Address - Fax:319-342-3627
Practice Address - Street 1:410 HIGHWAY 218 NORTH
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651
Practice Address - Country:US
Practice Address - Phone:319-342-3622
Practice Address - Fax:319-342-3627
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15280OtherWELLMARK BCBS OF IOWA
IA0152001Medicaid
IA42110449900001OtherBLUE DENTAL