Provider Demographics
NPI:1275633794
Name:PIPO, MICHAEL JOSEPH JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:PIPO
Suffix:JR
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:PO BOX 662
Mailing Address - Street 2:970 MAIN STREET
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-0662
Mailing Address - Country:US
Mailing Address - Phone:304-527-4444
Mailing Address - Fax:304-527-0869
Practice Address - Street 1:970 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1450
Practice Address - Country:US
Practice Address - Phone:304-527-4444
Practice Address - Fax:304-527-0869
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV28681223G0001X
OH30 . 0182671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0639214Medicaid
WV0132528000Medicaid
1000002868 WVOtherDELTA DENTAL