Provider Demographics
NPI:1053405936
Name:THOMAS R TIPPINSDDS PC
Entity type:Organization
Organization Name:THOMAS R TIPPINSDDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:TIPPINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-276-8395
Mailing Address - Street 1:3124 104TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3818
Mailing Address - Country:US
Mailing Address - Phone:515-276-7925
Mailing Address - Fax:515-276-7139
Practice Address - Street 1:3124 104TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3818
Practice Address - Country:US
Practice Address - Phone:515-276-7925
Practice Address - Fax:515-276-7139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty