Provider Demographics
NPI:1265596944
Name:CHIPPS, EDWARD A (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:A
Last Name:CHIPPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:11790 NORTHFALL LN
Mailing Address - Street 2:#401
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-7965
Mailing Address - Country:US
Mailing Address - Phone:770-777-0511
Mailing Address - Fax:770-777-0531
Practice Address - Street 1:11790 NORTHFALL LN
Practice Address - Street 2:#401
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-7965
Practice Address - Country:US
Practice Address - Phone:770-777-0511
Practice Address - Fax:770-777-0531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist