Provider Demographics
NPI:1528192226
Name:SHIPE, BRUCE VICKERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:VICKERS
Last Name:SHIPE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-1600
Mailing Address - Country:US
Mailing Address - Phone:724-852-1617
Mailing Address - Fax:
Practice Address - Street 1:1135 8TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1600
Practice Address - Country:US
Practice Address - Phone:724-852-1617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-020509-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice