Healthcare Provider Details

I. General information

NPI: 1598900938
Provider Name (Legal Business Name): PIPHO FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 HIGHWAY 218 N
LA PORTE CITY IA
50651-1009
US

IV. Provider business mailing address

PO BOX 196
LA PORTE CITY IA
50651-0196
US

V. Phone/Fax

Practice location:
  • Phone: 319-342-3622
  • Fax: 319-342-3627
Mailing address:
  • Phone: 319-342-3622
  • Fax: 319-342-3627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8556
License Number StateIA

VIII. Authorized Official

Name: ROBERT RAYMOND PIPHO
Title or Position: DENTIST
Credential: D.D.S.
Phone: 319-342-3622