Provider Demographics
NPI:1538221627
Name:CRIPE, PAUL ELLIS (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ELLIS
Last Name:CRIPE
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 1:2180 GOLDEN CENTRE LN STE 40
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4479
Mailing Address - Country:US
Mailing Address - Phone:916-635-2100
Mailing Address - Fax:916-635-4643
Practice Address - Street 1:2180 GOLDEN CENTRE LN STE 40
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4479
Practice Address - Country:US
Practice Address - Phone:916-635-2100
Practice Address - Fax:916-635-4643
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist