Healthcare Provider Details

I. General information

NPI: 1538172010
Provider Name (Legal Business Name): DAVID DEAN SIPPY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 6TH AVE
NEW GLARUS WI
53574
US

IV. Provider business mailing address

N8588 ZENTNER RD
NEW GLARUS WI
53574-8881
US

V. Phone/Fax

Practice location:
  • Phone: 608-527-2121
  • Fax: 608-930-3031
Mailing address:
  • Phone: 608-527-2121
  • Fax: 608-930-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3891
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: