Provider Demographics
NPI:1013392083
Name:PHIPPS, DON (DMD)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 PALM AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3718
Mailing Address - Country:US
Mailing Address - Phone:530-885-0697
Mailing Address - Fax:
Practice Address - Street 1:161 PALM AVE STE 12
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3718
Practice Address - Country:US
Practice Address - Phone:530-885-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist