Provider Demographics
NPI:1598900938
Name:PIPHO FAMILY DENTISTRY
Entity Type:Organization
Organization Name:PIPHO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:PIPHO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-342-3622
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651-0196
Mailing Address - Country:US
Mailing Address - Phone:319-342-3622
Mailing Address - Fax:319-342-3627
Practice Address - Street 1:410 HIGHWAY 218 N
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651-1032
Practice Address - Country:US
Practice Address - Phone:319-342-3623
Practice Address - Fax:319-342-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA85561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty