Provider Demographics
NPI:1922072669
Name:TIPTON, CHANEY, BROWN, WALKUP & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:TIPTON, CHANEY, BROWN, WALKUP & ASSOCIATES, INC.
Other - Org Name:BRYAN DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:TIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-636-3163
Mailing Address - Street 1:442 W HIGH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1681
Mailing Address - Country:US
Mailing Address - Phone:419-636-3163
Mailing Address - Fax:419-636-5056
Practice Address - Street 1:442 W HIGH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1681
Practice Address - Country:US
Practice Address - Phone:419-636-3163
Practice Address - Fax:419-636-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300196691223G0001X
OH300153031223G0001X
OH300140801223G0001X
OH300145121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH025860OtherCARL CHANEY - UCCI
OH30019669OtherCARL CHANEY-DELTA DENTAL
OH30021730OtherSHEA WALKUP
OH30021984OtherSCOTT BROWN-DENTAL DENTAL
OH30021730OtherSHEA WALKUP-DELTA DENTAL
OH30021984OtherSCOTT BROWN
OH0278097Medicaid
OH0924441Medicaid
OH0247718Medicaid
OH0320030Medicaid
OH0159117Medicaid
OH30015303OtherSTANLEY TIPTON-DELTAL DEN
OH885522OtherSTANLEY TIPTON - UCCI
OH0320030Medicaid