Individual
DR. KIP P ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
736 CAPITAL AVE SW, BATTLE CREEK, MI 49015-5018
(269) 968-9121
Mailing address
736 CAPITAL AVE SW, BATTLE CREEK, MI 49015-5018
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901018064
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4892200
—
MI
Enumeration date
08/31/2006
Last updated
07/08/2007
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