Healthcare Provider Details

I. General information

NPI: 1538274469
Provider Name (Legal Business Name): WILLIAM B. NIPPER, JR., D.M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 KINGSLEY AVE SUITE 1
ORANGE PARK FL
32073-4591
US

IV. Provider business mailing address

1414 KINGSLEY AVE SUITE 1
ORANGE PARK FL
32073-4591
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-4201
  • Fax: 904-269-1163
Mailing address:
  • Phone: 904-269-4201
  • Fax: 904-269-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 6934
License Number StateFL

VIII. Authorized Official

Name: DR. WILLIAM B. NIPPER JR.
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 904-269-4201