Provider Demographics
NPI:1063414209
Name:SIPES, DAVID L (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SIPES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 POLARIS PKWY
Mailing Address - Street 2:#220
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8024
Mailing Address - Country:US
Mailing Address - Phone:614-895-7280
Mailing Address - Fax:614-895-8826
Practice Address - Street 1:110 POLARIS PKWY
Practice Address - Street 2:#220
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8024
Practice Address - Country:US
Practice Address - Phone:614-895-7280
Practice Address - Fax:614-895-8826
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300152121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice