Provider Demographics
NPI:1851331748
Name:CRIPE, MATTHEW VINCENT (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:VINCENT
Last Name:CRIPE
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 1:303 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047
Mailing Address - Country:US
Mailing Address - Phone:269-782-5511
Mailing Address - Fax:269-782-5244
Practice Address - Street 1:303 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047
Practice Address - Country:US
Practice Address - Phone:269-782-5511
Practice Address - Fax:269-782-5244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID156611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice