Provider Demographics
NPI:1710106380
Name:SHIPLEY, SCOTT E (DDS)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:SHIPLEY
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 1:1904 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3701
Mailing Address - Country:US
Mailing Address - Phone:574-376-4244
Mailing Address - Fax:574-306-2711
Practice Address - Street 1:1904 E CENTER ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3701
Practice Address - Country:US
Practice Address - Phone:574-376-4244
Practice Address - Fax:574-306-2711
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120093101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351843855OtherTAX IDENTIFICATION NUMBER