Healthcare Provider Details

I. General information

NPI: 1902013949
Provider Name (Legal Business Name): DALE L CIPRA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10925 ANTIOCH RD SUITE 201
OVERLAND PARK KS
66210-2109
US

IV. Provider business mailing address

10925 ANTIOCH RD SUITE 201
OVERLAND PARK KS
66210-2109
US

V. Phone/Fax

Practice location:
  • Phone: 913-498-9595
  • Fax: 913-498-9696
Mailing address:
  • Phone: 913-498-9595
  • Fax: 913-498-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7096
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: