Provider Demographics
NPI:1093034365
Name:CHARLES H. KIPLE D.D.S., P.C.
Entity Type:Organization
Organization Name:CHARLES H. KIPLE D.D.S., P.C.
Other - Org Name:MORNINGSIDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:KIPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-276-2206
Mailing Address - Street 1:4704 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3020
Mailing Address - Country:US
Mailing Address - Phone:712-276-2206
Mailing Address - Fax:712-276-7247
Practice Address - Street 1:4704 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3020
Practice Address - Country:US
Practice Address - Phone:712-276-2206
Practice Address - Fax:712-276-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA60054OtherAETNA