Provider Demographics
NPI:1073529194
Name:RIPLEY, CHRIS LANE (DDS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:LANE
Last Name:RIPLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 HALLSTROM DR
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-3840
Mailing Address - Country:US
Mailing Address - Phone:651-385-9336
Mailing Address - Fax:
Practice Address - Street 1:217 PLUM ST
Practice Address - Street 2:SUITE 240
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2351
Practice Address - Country:US
Practice Address - Phone:651-388-8817
Practice Address - Fax:651-388-8818
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist