Provider Demographics
NPI:1922181809
Name:WILLIAM H E KIEPER DDS PA
Entity Type:Organization
Organization Name:WILLIAM H E KIEPER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H E
Authorized Official - Last Name:KIEPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-358-3120
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069
Mailing Address - Country:US
Mailing Address - Phone:320-358-3120
Mailing Address - Fax:320-358-3288
Practice Address - Street 1:780 WEST 4TH STREET
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069
Practice Address - Country:US
Practice Address - Phone:320-358-3120
Practice Address - Fax:320-358-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7652MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5464614OtherSTATE TAX ID #