Provider Demographics
NPI:1982180816
Name:RIPP, KEVIN D (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:RIPP
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 1:4112 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3395
Mailing Address - Country:US
Mailing Address - Phone:308-236-9694
Mailing Address - Fax:
Practice Address - Street 1:4112 6TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3395
Practice Address - Country:US
Practice Address - Phone:308-236-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7779122300000X
SDD1243122300000X
OKRES-1344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist