Healthcare Provider Details

I. General information

NPI: 1902807142
Provider Name (Legal Business Name): WILLIAM THURMAN SHIPLEY SR. D.D.S M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N OAK AVE
COOKEVILLE TN
38501-2439
US

IV. Provider business mailing address

303 N OAK AVE
COOKEVILLE TN
38501-2439
US

V. Phone/Fax

Practice location:
  • Phone: 931-526-7846
  • Fax:
Mailing address:
  • Phone: 931-526-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS 1549
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: