Provider Demographics
NPI:1033112180
Name:TIPPS, STEVEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:TIPPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 SHALLOWFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1688
Mailing Address - Country:US
Mailing Address - Phone:423-893-3333
Mailing Address - Fax:423-954-3054
Practice Address - Street 1:6015 SHALLOWFORD ROAD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1688
Practice Address - Country:US
Practice Address - Phone:423-893-3333
Practice Address - Fax:423-954-3054
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3511204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0050858OtherBCBSTN PROVDER NUMBER
TN3225000Medicaid
TN4665225OtherAETNA PROVIDER NUMBER
TN4665225OtherAETNA PROVIDER NUMBER
TN0050858OtherBCBSTN PROVDER NUMBER
TNT74390Medicare UPIN