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General NPI Number Information
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NPI Number | 1629698600
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Entity Type | Individual
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Provider Name | SPENCER WILLIAM TIPPETS DDS
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Gender | Male
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Dates
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Enumeration Date | 04/20/2020
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 348 OAK ST
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City | CENTRAL POINT
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State | OR
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Zip | 97502-2241
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Country | US
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Telephone | 541-664-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 348 OAK ST
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City | CENTRAL POINT
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State | OR
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Zip | 97502-2241
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Country | US
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Telephone | 541-664-2210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D5263
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12196797-9923
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11574
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License Number State | OR
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