Provider Demographics
NPI:1023204187
Name:YANCY T. SIPES DDS PS
Entity Type:Organization
Organization Name:YANCY T. SIPES DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YANCY
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:SIPES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-886-1300
Mailing Address - Street 1:31527 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BLACK DIAMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98010-9731
Mailing Address - Country:US
Mailing Address - Phone:360-886-1300
Mailing Address - Fax:360-886-9848
Practice Address - Street 1:31527 3RD AVE
Practice Address - Street 2:
Practice Address - City:BLACK DIAMOND
Practice Address - State:WA
Practice Address - Zip Code:98010-9731
Practice Address - Country:US
Practice Address - Phone:360-886-1300
Practice Address - Fax:360-886-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE0009945261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental