Provider Demographics
NPI:1346250917
Name:IPPISCH, KEVIN D (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:IPPISCH
Suffix:
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 1787
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-476-3200
Mailing Address - Fax:831-476-2775
Practice Address - Street 1:9000 SOQUEL AVE
Practice Address - Street 2:STE 202
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062
Practice Address - Country:US
Practice Address - Phone:831-476-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice