Provider Demographics
NPI:1619986791
Name:SHIPP, PHILLIP PALMER IV (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:PALMER
Last Name:SHIPP
Suffix:IV
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 1:820 SHERROD AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-3438
Mailing Address - Country:US
Mailing Address - Phone:615-554-9339
Mailing Address - Fax:
Practice Address - Street 1:2126 HELTON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1449
Practice Address - Country:US
Practice Address - Phone:256-764-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7126332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies