Provider Demographics
NPI:1992566756
Name:SPENCER TIPPETS, DDS, LLC
Entity type:Organization
Organization Name:SPENCER TIPPETS, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TIPPETS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-664-2210
Mailing Address - Street 1:348 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2241
Mailing Address - Country:US
Mailing Address - Phone:541-664-2210
Mailing Address - Fax:
Practice Address - Street 1:348 OAK ST
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2241
Practice Address - Country:US
Practice Address - Phone:541-664-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental