MEDICARE: WILLIAM H E KIEPER DDS PA

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	1223G0001X	General Practice Dentistry	7652MN	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5464614	OTHER	MN	STATE TAX ID #

General Provider Information

NPI Number	:	1922181809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM H E KIEPER DDS PA

Provider Business Mailing Address
First Line	:	PO BOX 26
Second Line	:
City	:	RUSH CITY
State	:	MN
Zip	:	55069
Country	:	US
Telephone Number	:	320-358-3120
Fax Number	:	320-358-3288

Provider Business Practice Location Address
First Line	:	780 WEST 4TH STREET
Second Line	:
City	:	RUSH CITY
State	:	MN
Zip	:	55069
Country	:	US
Telephone Number	:	320-358-3120
Fax Number	:	320-358-3288

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM H E KIEPER
Credential	:	DDS
Telephone Number	:	320-358-3120

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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