Provider Demographics
NPI:1952316739
Name:RIPPEON, AUSTIN DELMAR JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:DELMAR
Last Name:RIPPEON
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 200
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4409
Mailing Address - Country:US
Mailing Address - Phone:301-663-6500
Mailing Address - Fax:301-663-6500
Practice Address - Street 1:180 THOMAS JOHNSON DR
Practice Address - Street 2:STE 200
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4409
Practice Address - Country:US
Practice Address - Phone:301-663-6500
Practice Address - Fax:301-663-6500
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD92791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice