Provider Demographics
NPI:1447477666
Name:DONN G. KIPKA, JR., D.D.S., P.C.
Entity type:Organization
Organization Name:DONN G. KIPKA, JR., D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KIPKA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:906-228-7087
Mailing Address - Street 1:1010 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3510
Mailing Address - Country:US
Mailing Address - Phone:906-228-7087
Mailing Address - Fax:906-226-2087
Practice Address - Street 1:1010 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3510
Practice Address - Country:US
Practice Address - Phone:906-228-7087
Practice Address - Fax:906-226-2087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010104451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty