Provider Demographics
NPI:1730347337
Name:DONNA D PIPHO DDS
Entity type:Organization
Organization Name:DONNA D PIPHO DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIANNE
Authorized Official - Middle Name:VIOLET
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:319-342-3622
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:DONNA D PIPHO DDS
Mailing Address - City:LA PORTE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50651
Mailing Address - Country:US
Mailing Address - Phone:319-342-3622
Mailing Address - Fax:319-342-3627
Practice Address - Street 1:410 HIGHWAY 218 NORTH
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651
Practice Address - Country:US
Practice Address - Phone:319-342-3622
Practice Address - Fax:319-342-3627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0152801Medicaid