Provider Demographics
NPI:1558404897
Name:NIP, CHARLES C (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:NIP
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 1:2243 VAN NESS AVE
Mailing Address - Street 2:# 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-441-2098
Mailing Address - Fax:415-441-3488
Practice Address - Street 1:2243 VAN NESS AVE
Practice Address - Street 2:# 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-441-2098
Practice Address - Fax:415-441-3488
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist