MEDICARE: DR. YANCY THEODORE SIPES D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D-05255	ID

General Provider Information

NPI Number	:	1811054976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YANCY THEODORE SIPES D.D.S.

Provider Business Mailing Address
First Line	:	1613 12TH AVE RD STE A
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6183
Country	:	US
Telephone Number	:	208-467-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 12TH AVE RD STE A
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6183
Country	:	US
Telephone Number	:	208-467-0079
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2007
Last Update Date	:	02/26/2024

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