Healthcare Provider Details

I. General information

NPI: 1346839776
Provider Name (Legal Business Name): TIPTON DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S OSAGE AVE
TIPTON MO
65081-8470
US

IV. Provider business mailing address

303 S OSAGE AVE
TIPTON MO
65081-8470
US

V. Phone/Fax

Practice location:
  • Phone: 660-433-5741
  • Fax:
Mailing address:
  • Phone: 660-433-5741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOEL CHAPPELL
Title or Position: PRESIDENT
Credential: DDS
Phone: 210-789-0202