Healthcare Provider Details

I. General information

NPI: 1750732509
Provider Name (Legal Business Name): BRANDON RIPPY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AREA SPT GRP KUWAIT
ARIFJAN KUWAIT
09366
KW

IV. Provider business mailing address

AREA SPT GRP KUWAIT
ARIFJAN KUWAIT
09366
KW

V. Phone/Fax

Practice location:
  • Phone: 210-760-9319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: