Provider Demographics
NPI:1639323017
Name:CHIPIAN, E. TERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:TERRY
Last Name:CHIPIAN
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 1:9495 S 700 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3459
Mailing Address - Country:US
Mailing Address - Phone:801-553-1800
Mailing Address - Fax:801-553-0212
Practice Address - Street 1:9495 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3459
Practice Address - Country:US
Practice Address - Phone:801-553-1800
Practice Address - Fax:801-553-0212
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1428361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics