Provider Demographics
NPI:1083938203
Name:MARK A. TRIPP & ASSOCIATES
Entity Type:Organization
Organization Name:MARK A. TRIPP & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-845-5538
Mailing Address - Street 1:1230 MANN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5535
Mailing Address - Country:US
Mailing Address - Phone:704-845-5538
Mailing Address - Fax:704-847-6508
Practice Address - Street 1:1230 MANN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5535
Practice Address - Country:US
Practice Address - Phone:704-845-5538
Practice Address - Fax:704-847-6508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8256OtherCIGNA
NC8356OtherCIGNA
NC8256OtherDELTA DENTAL
NC7034OtherCIGNA
NC8861OtherCIGNA
NC8356OtherDELTA DENTAL
NC8861OtherDELTA DENTAL
NC7034OtherDELTA DENTAL