Provider Demographics
NPI:1154680122
Name:RICHARD A. WHIPPLE D.D.S
Entity Type:Organization
Organization Name:RICHARD A. WHIPPLE D.D.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-620-6133
Mailing Address - Street 1:11525 SW DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3475
Mailing Address - Country:US
Mailing Address - Phone:503-620-6133
Mailing Address - Fax:
Practice Address - Street 1:11525 SW DURHAM RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3475
Practice Address - Country:US
Practice Address - Phone:503-620-6133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty