Healthcare Provider Details

I. General information

NPI: 1033112180
Provider Name (Legal Business Name): STEVEN P TIPPS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 SHALLOWFORD ROAD
CHATTANOOGA TN
37421-1688
US

IV. Provider business mailing address

6015 SHALLOWFORD ROAD
CHATTANOOGA TN
37421-1688
US

V. Phone/Fax

Practice location:
  • Phone: 423-893-3333
  • Fax: 423-954-3054
Mailing address:
  • Phone: 423-893-3333
  • Fax: 423-954-3054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number3511
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: