Provider Demographics
NPI:1619986791
Name:SHIPP, PHILLIP PALMER IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:PALMER
Last Name:SHIPP
Suffix:IV
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 1:4515 HARDING RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205
Mailing Address - Country:US
Mailing Address - Phone:615-292-4100
Mailing Address - Fax:615-292-4181
Practice Address - Street 1:4515 HARDING RD
Practice Address - Street 2:SUITE 312
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205
Practice Address - Country:US
Practice Address - Phone:615-292-4100
Practice Address - Fax:615-292-4181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71261223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies