Provider Demographics
NPI:1396984878
Name:TERRY TIPPIN, D.M.D., P.L.C.
Entity type:Organization
Organization Name:TERRY TIPPIN, D.M.D., P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,PLC
Authorized Official - Phone:904-261-5811
Mailing Address - Street 1:132 SOUTHERN BLVD.
Mailing Address - Street 2:OAK PARK DENTAL
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-7414
Mailing Address - Country:US
Mailing Address - Phone:912-356-5444
Mailing Address - Fax:912-356-1837
Practice Address - Street 1:2800 UNIVERSITY BLVD. NORTH
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3394
Practice Address - Country:US
Practice Address - Phone:904-256-7849
Practice Address - Fax:904-256-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN70251223X0400X
GADN0087301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty