Provider Demographics
NPI:1831301951
Name:TIPTON, BLAYNE HILLYARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAYNE
Middle Name:HILLYARD
Last Name:TIPTON
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 1:307 G CARPENTER DAM ROAD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-520-5437
Mailing Address - Fax:501-520-5433
Practice Address - Street 1:307 G CARPENTER DAM ROAD
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-520-5437
Practice Address - Fax:501-520-5433
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154429608Medicaid