Provider Demographics
NPI:1639372683
Name:CRIPPS, CHARLES ERNEST (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ERNEST
Last Name:CRIPPS
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 1:9368 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:PINON HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92372-9781
Mailing Address - Country:US
Mailing Address - Phone:760-868-5262
Mailing Address - Fax:760-868-5262
Practice Address - Street 1:22844 VIRGINIA BL.
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505
Practice Address - Country:US
Practice Address - Phone:760-373-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26370122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26370OtherDDS