Provider Demographics
NPI:1871509877
Name:ZIPPERLEN, WAYNE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:ZIPPERLEN
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 1:11925 LITHOPOLIS RD NW
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9585
Mailing Address - Country:US
Mailing Address - Phone:614-837-6688
Mailing Address - Fax:614-834-4555
Practice Address - Street 1:11925 LITHOPOLIS RD NW
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9585
Practice Address - Country:US
Practice Address - Phone:614-837-6688
Practice Address - Fax:614-834-4555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14874122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist