Provider Demographics
NPI:1679860969
Name:WILLIAM T. SHIPLEY, D.D.S., M.S.D.
Entity Type:Organization
Organization Name:WILLIAM T. SHIPLEY, D.D.S., M.S.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THURMAN
Authorized Official - Last Name:SHIPLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:931-626-7846
Mailing Address - Street 1:303 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2439
Mailing Address - Country:US
Mailing Address - Phone:931-526-7846
Mailing Address - Fax:
Practice Address - Street 1:303 N OAK AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2439
Practice Address - Country:US
Practice Address - Phone:931-526-7846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 1549261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3201385Medicaid