Healthcare Provider Details

I. General information

NPI: 1255475117
Provider Name (Legal Business Name): RYAN C. SHIPP DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9053 S PECOS RD STE 3000
HENDERSON NV
89074-7179
US

IV. Provider business mailing address

9053 S PECOS RD STE 3000
HENDERSON NV
89074-7179
US

V. Phone/Fax

Practice location:
  • Phone: 702-798-0911
  • Fax: 702-798-4723
Mailing address:
  • Phone: 702-798-0911
  • Fax: 702-798-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number5491
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD-4207-EN
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberS7-55
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: