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General NPI Number Information
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NPI Number | 1396984878
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Entity Type | Organization
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Legal Business Name | TERRY TIPPIN, D.M.D., P.L.C.
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 02/06/2009
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Provider Practice Location Address
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Address Line | 2800 UNIVERSITY BLVD. NORTH
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City | JACKSONVILLE
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State | FL
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Zip | 32211-3394
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Country | US
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Telephone | 904-256-7849
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Fax | 904-256-7845
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Provider Business Mailing Address
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Address Line | 132 SOUTHERN BLVD. OAK PARK DENTAL
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City | SAVANNAH
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State | GA
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Zip | 31405-7414
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Country | US
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Telephone | 912-356-5444
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Fax | 912-356-1837
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. TERRY TIPPIN
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Credential | D.M.D.,P.L.C.
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Telephone | 904-261-5811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN7025
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN008730
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License Number State | GA
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