Provider Demographics
NPI:1306003777
Name:TIPPETS, DERREN ELVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DERREN
Middle Name:ELVIS
Last Name:TIPPETS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TESSITORE CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5689
Mailing Address - Country:US
Mailing Address - Phone:856-206-2164
Mailing Address - Fax:
Practice Address - Street 1:100 TESSITORE CT
Practice Address - Street 2:SUITE C
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5689
Practice Address - Country:US
Practice Address - Phone:856-206-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry