Provider Demographics
NPI:1164569638
Name:WEST END DENTAL
Entity Type:Organization
Organization Name:WEST END DENTAL
Other - Org Name:JAMES A KRIPPAEHNE DMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRIPPAEHNE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-224-7815
Mailing Address - Street 1:833 SW 11TH AVE
Mailing Address - Street 2:#300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2117
Mailing Address - Country:US
Mailing Address - Phone:503-224-7815
Mailing Address - Fax:503-222-0029
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:#300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2117
Practice Address - Country:US
Practice Address - Phone:503-224-7815
Practice Address - Fax:503-222-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR=========OtherTIN#