Provider Demographics
NPI:1699723189
Name:RIPLEY, REBECCA ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ELLEN
Last Name:RIPLEY
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 1:113 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041-1635
Mailing Address - Country:US
Mailing Address - Phone:651-345-3335
Mailing Address - Fax:651-345-3336
Practice Address - Street 1:113 W CENTER ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1635
Practice Address - Country:US
Practice Address - Phone:651-345-3335
Practice Address - Fax:651-345-3336
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11816122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist