Provider Demographics
NPI:1902807142
Name:SHIPLEY, WILLIAM THURMAN SR (DDS MSD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THURMAN
Last Name:SHIPLEY
Suffix:SR
Gender:M
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2439
Mailing Address - Country:US
Mailing Address - Phone:931-526-7846
Mailing Address - Fax:
Practice Address - Street 1:303 N OAK AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2439
Practice Address - Country:US
Practice Address - Phone:931-526-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 15491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNSH 3201385Medicaid