Provider Demographics
NPI:1841686649
Name:CASCADE DENTAL, PC
Entity type:Organization
Organization Name:CASCADE DENTAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIPPLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-994-2113
Mailing Address - Street 1:6532 N DOUBLE EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5103
Mailing Address - Country:US
Mailing Address - Phone:208-949-0239
Mailing Address - Fax:
Practice Address - Street 1:839 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:ID
Practice Address - Zip Code:83611
Practice Address - Country:US
Practice Address - Phone:208-382-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty