Provider Demographics
NPI:1336273309
Name:TIPTON, FELINES HORNILLA (DDS)
Entity Type:Individual
Prefix:
First Name:FELINES
Middle Name:HORNILLA
Last Name:TIPTON
Suffix:
Gender:F
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:PO BOX 6160
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6160
Mailing Address - Country:US
Mailing Address - Phone:707-443-7043
Mailing Address - Fax:707-443-1375
Practice Address - Street 1:805 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4541
Practice Address - Country:US
Practice Address - Phone:707-443-7043
Practice Address - Fax:707-443-1375
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA436851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice