Provider Demographics
NPI:1245656008
Name:TIPPIT DENTAL GROUP CYPRESS PLLC
Entity type:Organization
Organization Name:TIPPIT DENTAL GROUP CYPRESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHR,AABA
Authorized Official - Phone:713-465-1860
Mailing Address - Street 1:9099 KATY FWY
Mailing Address - Street 2:140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1640
Mailing Address - Country:US
Mailing Address - Phone:713-465-1860
Mailing Address - Fax:713-932-0564
Practice Address - Street 1:23800 NORTHWEST FWY
Practice Address - Street 2:201
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5747
Practice Address - Country:US
Practice Address - Phone:281-220-1855
Practice Address - Fax:281-220-1857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIPPIT DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23886305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization