Provider Demographics
NPI:1194175679
Name:FLIPPEN, ROGER (DDS)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:FLIPPEN
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 1:2735 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1466
Mailing Address - Country:US
Mailing Address - Phone:205-956-8977
Mailing Address - Fax:
Practice Address - Street 1:3920 GRANTS MILL RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-1204
Practice Address - Country:US
Practice Address - Phone:205-956-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6314122300000X
TX31923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist