Provider Demographics
NPI:1578677688
Name:KNIPE, KENNETH DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DEAN
Last Name:KNIPE
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 1:1253 COCOA AVENUE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1715
Mailing Address - Country:US
Mailing Address - Phone:717-534-2545
Mailing Address - Fax:717-533-8887
Practice Address - Street 1:1253 COCOA AVENUE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1715
Practice Address - Country:US
Practice Address - Phone:717-534-2545
Practice Address - Fax:717-533-8887
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023724L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30392Medicare UPIN
PA432223Medicare ID - Type Unspecified