Provider Demographics
NPI:1295835767
Name:PIPKIN, WALTER LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:LEE
Last Name:PIPKIN
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 1:6912 E RENO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110
Mailing Address - Country:US
Mailing Address - Phone:405-737-6622
Mailing Address - Fax:405-733-2250
Practice Address - Street 1:6912 E RENO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110
Practice Address - Country:US
Practice Address - Phone:405-737-6622
Practice Address - Fax:405-733-2250
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice