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General NPI Number Information
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NPI Number | 1538274469
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Entity Type | Organization
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Legal Business Name | WILLIAM B. NIPPER, JR., D.M.D., P.A.
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 1414 KINGSLEY AVE SUITE 1
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City | ORANGE PARK
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State | FL
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Zip | 32073-4591
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Country | US
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Telephone | 904-269-4201
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Fax | 904-269-1163
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Provider Business Mailing Address
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Address Line | 1414 KINGSLEY AVE SUITE 1
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City | ORANGE PARK
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State | FL
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Zip | 32073-4591
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Country | US
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Telephone | 904-269-4201
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Fax | 904-269-1163
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM B. NIPPER JR.
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Credential | D.M.D.
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Telephone | 904-269-4201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN 6934
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License Number State | FL
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