Healthcare Provider Details

I. General information

NPI: 1992729131
Provider Name (Legal Business Name): JAMES BERNARD DIPPEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7139 UPPER MOUNT VERNON RD
EVANSVILLE IN
47712-2985
US

IV. Provider business mailing address

7139 UPPER MOUNT VERNON RD
EVANSVILLE IN
47712-2985
US

V. Phone/Fax

Practice location:
  • Phone: 812-146-4118
  • Fax: 812-424-2967
Mailing address:
  • Phone: 812-146-4118
  • Fax: 812-424-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7983
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: