Provider Demographics
NPI:1023602869
Name:CEDAR RIDGE DENTAL OF TIPTON
Entity type:Organization
Organization Name:CEDAR RIDGE DENTAL OF TIPTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:PUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-886-1800
Mailing Address - Street 1:100 COMMERCE BLVD
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IA
Mailing Address - Zip Code:52772-1768
Mailing Address - Country:US
Mailing Address - Phone:563-886-1800
Mailing Address - Fax:
Practice Address - Street 1:100 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IA
Practice Address - Zip Code:52772-1768
Practice Address - Country:US
Practice Address - Phone:563-886-1800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty