Provider Demographics
NPI:1548371446
Name:KIPLE, CHARLES HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOWARD
Last Name:KIPLE
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 1:4016 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2459
Mailing Address - Country:US
Mailing Address - Phone:712-276-2206
Mailing Address - Fax:712-276-7247
Practice Address - Street 1:4016 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-2459
Practice Address - Country:US
Practice Address - Phone:712-276-2206
Practice Address - Fax:712-276-7247
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1451575Medicaid