Healthcare Provider Details

I. General information

NPI: 1255006532
Provider Name (Legal Business Name): TIPPIT DENTAL GROUP ELGIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 N AVENUE C
ELGIN TX
78621-1528
US

IV. Provider business mailing address

9099 KATY FWY STE 140
HOUSTON TX
77024-1632
US

V. Phone/Fax

Practice location:
  • Phone: 512-281-4260
  • Fax:
Mailing address:
  • Phone: 713-465-1860
  • 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: MS. THERESA NAVARRO
Title or Position: CFO
Credential:
Phone: 713-677-9983