Provider Demographics
NPI:1164698411
Name:WESLEY E. NIPPER DDS PC
Entity Type:Organization
Organization Name:WESLEY E. NIPPER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-762-7551
Mailing Address - Street 1:400 FAIRVIEW AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1920
Mailing Address - Country:US
Mailing Address - Phone:580-762-7551
Mailing Address - Fax:
Practice Address - Street 1:400 FAIRVIEW AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1920
Practice Address - Country:US
Practice Address - Phone:580-762-7551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1048302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization