Provider Demographics
NPI:1689840977
Name:SHERRY CHANCE PIPPEN, DMD, PA
Entity Type:Organization
Organization Name:SHERRY CHANCE PIPPEN, DMD, PA
Other - Org Name:OAK LANE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:CHANCE
Authorized Official - Last Name:PIPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-587-7737
Mailing Address - Street 1:PO BOX 2014
Mailing Address - Street 2:
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 1:823 F E SELLERS HWY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-9378
Practice Address - Country:US
Practice Address - Phone:601-587-7737
Practice Address - Fax:601-587-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3267-031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty