Provider Demographics
NPI:1386719532
Name:PIPER, RENEE MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MARIE
Last Name:PIPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:205 NW 1ST STREET
Mailing Address - City:MULLEN
Mailing Address - State:NE
Mailing Address - Zip Code:69152
Mailing Address - Country:US
Mailing Address - Phone:308-546-2495
Mailing Address - Fax:
Practice Address - Street 1:205 NW 1ST STREET
Practice Address - Street 2:
Practice Address - City:MULLEN
Practice Address - State:NE
Practice Address - Zip Code:69152
Practice Address - Country:US
Practice Address - Phone:308-546-2495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEBP6262771N208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47084331240Medicaid