Provider Demographics
NPI:1154654101
Name:ATTATHOM, TIPAPAT (DDS, MS)
Entity Type:Individual
Prefix:MISS
First Name:TIPAPAT
Middle Name:
Last Name:ATTATHOM
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OPERATIVE DENTISTRY, DSB, COLLEGE OF DENTISTRY
Mailing Address - Street 2:UNIVERSITY OF IOWA
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1010
Mailing Address - Country:US
Mailing Address - Phone:319-621-1272
Mailing Address - Fax:
Practice Address - Street 1:OPERATIVE DENTISTRY, DSB, COLLEGE OF DENTISTRY
Practice Address - Street 2:UNIVERSITY OF IOWA
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1010
Practice Address - Country:US
Practice Address - Phone:319-621-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA#30246122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist