Provider Demographics
NPI:1538274469
Name:WILLIAM B. NIPPER, JR., D.M.D., P.A.
Entity type:Organization
Organization Name:WILLIAM B. NIPPER, JR., D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:NIPPER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-269-4201
Mailing Address - Street 1:1414 KINGSLEY AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4591
Mailing Address - Country:US
Mailing Address - Phone:904-269-4201
Mailing Address - Fax:904-269-1163
Practice Address - Street 1:1414 KINGSLEY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4591
Practice Address - Country:US
Practice Address - Phone:904-269-4201
Practice Address - Fax:904-269-1163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 69341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty