Provider Demographics
NPI:1952373490
Name:KIPLING, BONITA JOANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:JOANN
Last Name:KIPLING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3329
Mailing Address - Country:US
Mailing Address - Phone:937-339-1115
Mailing Address - Fax:937-339-5225
Practice Address - Street 1:318 S MARKET ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3329
Practice Address - Country:US
Practice Address - Phone:937-339-1115
Practice Address - Fax:937-339-5225
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0201151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0163228Medicaid