Provider Demographics
NPI:1679606594
Name:RIPA, VYACHESLAV (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:VYACHESLAV
Middle Name:
Last Name:RIPA
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2833 CONEY ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5015
Mailing Address - Country:US
Mailing Address - Phone:718-946-8585
Mailing Address - Fax:347-254-6525
Practice Address - Street 1:2833 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5015
Practice Address - Country:US
Practice Address - Phone:718-946-8585
Practice Address - Fax:347-254-6525
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049788-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227829Medicaid