Healthcare Provider Details

I. General information

NPI: 1386688604
Provider Name (Legal Business Name): DARREN M RIOPELLE DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SOUTH MAIN STREET
ITHACA MI
48847
US

IV. Provider business mailing address

108 SOUTH MAIN STREET
ITHACA MI
48847
US

V. Phone/Fax

Practice location:
  • Phone: 989-875-4832
  • Fax: 989-875-3927
Mailing address:
  • Phone: 989-875-4832
  • Fax: 989-875-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16820
License Number StateMI

VIII. Authorized Official

Name: DR. DARREN M RIOPELLE
Title or Position: DENTIST OWNER
Credential: DDS
Phone: 929-875-4832