Provider Demographics
NPI:1982779658
Name:CHIAPPETTA, FERDINAND CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:CARL
Last Name:CHIAPPETTA
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 1:6121 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-4506
Mailing Address - Country:US
Mailing Address - Phone:262-654-6535
Mailing Address - Fax:262-654-3358
Practice Address - Street 1:6121 7TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-4506
Practice Address - Country:US
Practice Address - Phone:262-654-6535
Practice Address - Fax:262-654-3358
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50020141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33404700Medicaid