Provider Demographics
NPI:1649201591
Name:PIPPEN, SHERRY C (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:C
Last Name:PIPPEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2014
Mailing Address - Street 2:823 FE SELLERS HWY
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-2014
Mailing Address - Country:US
Mailing Address - Phone:601-587-7737
Mailing Address - Fax:601-587-9457
Practice Address - Street 1:825 HIGHWAY 27
Practice Address - Street 2:823 FE SELLERS HWY
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-9109
Practice Address - Country:US
Practice Address - Phone:601-587-7737
Practice Address - Fax:601-587-9457
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3267-03122300000X
MS3268-031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00623210Medicaid