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General NPI Number Information
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NPI Number | 1811488257
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Entity Type | Individual
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Provider Name | THOMAS ELLIS TIPPIT SR. DDS
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Gender | Male
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 4501 S STAPLES ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-7841
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Country | US
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Telephone | 361-992-8071
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Fax |
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Provider Business Mailing Address
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Address Line | 4501 S STAPLES ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411
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Country | US
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Telephone | 210-569-3784
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11389
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License Number State | TX
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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 | 11389
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License Number State | TX
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