Healthcare Provider Details

I. General information

NPI: 1669198701
Provider Name (Legal Business Name): RYAN C. SHIPP,DMD,MS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
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: 702-798-4723
  • Fax: 702-798-0911
Mailing address:
  • Phone: 702-798-4723
  • Fax: 702-798-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE S KEANE-TRACHSEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-672-8860