Provider Demographics
NPI:1609885300
Name:TIPTON, ROGER (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:TIPTON
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:DR
Other - First Name:ROGER
Other - Middle Name:
Other - Last Name:TIPTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ROGER TIPTON
Mailing Address - Street 1:6102 82ND ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3690
Mailing Address - Country:US
Mailing Address - Phone:806-792-2288
Mailing Address - Fax:806-792-2768
Practice Address - Street 1:6102 82ND ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3690
Practice Address - Country:US
Practice Address - Phone:806-792-2288
Practice Address - Fax:806-792-2768
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry