Provider Demographics
NPI:1568481950
Name:PIPPENGER, GARY R (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:PIPPENGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 E LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2818
Mailing Address - Country:US
Mailing Address - Phone:574-245-7503
Mailing Address - Fax:574-245-7502
Practice Address - Street 1:1005 E LASALLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2818
Practice Address - Country:US
Practice Address - Phone:574-245-7503
Practice Address - Fax:574-245-7502
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120067401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry