MEDICARE: DR. KIRK TRISTAN RIPLEY DDS MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	12008818	IN

General Provider Information

NPI Number	:	1225148091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK TRISTAN RIPLEY DDS MS

Provider Business Mailing Address
First Line	:	8849 SHELBY ST STE C2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6299
Country	:	US
Telephone Number	:	317-881-3997
Fax Number	:	317-882-8944

Provider Business Practice Location Address
First Line	:	8849 SHELBY ST STE C2
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6299
Country	:	US
Telephone Number	:	317-881-3997
Fax Number	:	317-882-8944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/12/2022

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