Provider Demographics
NPI:1891840534
Name:KENNETH R. TRIPP. JR. DDS, PA
Entity Type:Organization
Organization Name:KENNETH R. TRIPP. JR. DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-556-5566
Mailing Address - Street 1:1906 S MAIN ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5032
Mailing Address - Country:US
Mailing Address - Phone:919-556-5566
Mailing Address - Fax:919-562-5537
Practice Address - Street 1:1906 S MAIN ST
Practice Address - Street 2:SUITE 218
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-5032
Practice Address - Country:US
Practice Address - Phone:919-556-5566
Practice Address - Fax:919-562-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty