Provider Demographics
NPI:1316553738
Name:TIPPETS, GINA (RDH)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:TIPPETS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 N 175 E
Mailing Address - Street 2:
Mailing Address - City:NORTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84414-2624
Mailing Address - Country:US
Mailing Address - Phone:801-698-1321
Mailing Address - Fax:
Practice Address - Street 1:5990 FASHION POINT DR STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5179
Practice Address - Country:US
Practice Address - Phone:801-475-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7007595-9920124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist