Provider Demographics
NPI:1215180534
Name:WALTER LEE TIPPIN,DDS, P.C
Entity Type:Organization
Organization Name:WALTER LEE TIPPIN,DDS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TIPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:915-255-4200
Mailing Address - Street 1:3021 TRAWOOD DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4330
Mailing Address - Country:US
Mailing Address - Phone:915-855-4200
Mailing Address - Fax:915-855-4633
Practice Address - Street 1:3021 TRAWOOD DR
Practice Address - Street 2:SUITE 1B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4330
Practice Address - Country:US
Practice Address - Phone:915-855-4200
Practice Address - Fax:915-855-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091037401Medicaid
CAB1341201OtherDELTA DENTAL
PA600826OtherUNITED CONCORDIA TRICARE