Healthcare Provider Details

I. General information

NPI: 1841686649
Provider Name (Legal Business Name): CASCADE DENTAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 S MAIN STREET
CASCADE ID
83611
US

IV. Provider business mailing address

6532 N DOUBLE EAGLE LN
MERIDIAN ID
83646-5103
US

V. Phone/Fax

Practice location:
  • Phone: 208-382-8200
  • Fax:
Mailing address:
  • Phone: 208-949-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DAVID L RIPPLINGER
Title or Position: PRESIDENT
Credential: DDS
Phone: 208-994-2113