Provider Demographics
NPI:1205977006
Name:TIPPETS, ASHBY WOOD (DDS)
Entity type:Individual
Prefix:
First Name:ASHBY
Middle Name:WOOD
Last Name:TIPPETS
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 1:37 MT. MEADOW ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:LYMAN
Mailing Address - State:WY
Mailing Address - Zip Code:82937-0000
Mailing Address - Country:US
Mailing Address - Phone:307-786-4500
Mailing Address - Fax:
Practice Address - Street 1:37 MT. MEADOW ST.
Practice Address - Street 2:SUITE C
Practice Address - City:LYMAN
Practice Address - State:WY
Practice Address - Zip Code:82937
Practice Address - Country:US
Practice Address - Phone:307-786-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice