Provider Demographics
NPI:1447518089
Name:JEFFREY S TIPPETS DDS PC
Entity type:Organization
Organization Name:JEFFREY S TIPPETS DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TIPPETS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-587-8085
Mailing Address - Street 1:257 JOHNSTOWN CENTER DR
Mailing Address - Street 2:108
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-7846
Mailing Address - Country:US
Mailing Address - Phone:970-587-8085
Mailing Address - Fax:970-587-4131
Practice Address - Street 1:257 JOHNSTOWN CENTER DR
Practice Address - Street 2:108
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-7846
Practice Address - Country:US
Practice Address - Phone:970-587-8085
Practice Address - Fax:970-587-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty