Provider Demographics
NPI:1538317680
Name:PIPKIN, TERESA MARS (RDH)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARS
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:MARS
Other - Last Name:FORET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:748 CREPE MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5812
Mailing Address - Country:US
Mailing Address - Phone:757-409-5553
Mailing Address - Fax:
Practice Address - Street 1:1035 NIDER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8701
Practice Address - Country:US
Practice Address - Phone:757-953-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
VA0402004442124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
15538317680OtherDENTAL HYGIENIST