Provider Demographics
NPI:1275871741
Name:DAVID R. CLEPPE, D.D.S., PC
Entity Type:Organization
Organization Name:DAVID R. CLEPPE, D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLEPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-240-0720
Mailing Address - Street 1:8425 WOODFIELD CROSSING BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 S SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2847
Practice Address - Country:US
Practice Address - Phone:269-240-0720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011205A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901016781OtherDENTAL LICENSE
IN12011205AOtherDENTAL LICENSE
IN12011205AOtherDENTAL LICENSE