MEDICARE: DR. THOMAS ELLIS TIPPIT SR. DDS

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	11389	TX
2	122300000X	Dentist	11389	TX

General Provider Information

NPI Number	:	1811488257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS ELLIS TIPPIT SR. DDS

Provider Business Mailing Address
First Line	:	4501 S STAPLES ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411
Country	:	US
Telephone Number	:	210-569-3784
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 S STAPLES ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-7841
Country	:	US
Telephone Number	:	361-992-8071
Fax Number	:

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

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	11/20/2024

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