Provider Demographics
NPI:1720477466
Name:DR. DAVE L. HIPPENSTEEL DMD, PC
Entity Type:Organization
Organization Name:DR. DAVE L. HIPPENSTEEL DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:HIPPENSTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-272-9621
Mailing Address - Street 1:4849 THOMASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37035-5005
Mailing Address - Country:US
Mailing Address - Phone:215-272-9621
Mailing Address - Fax:
Practice Address - Street 1:1754 MADISON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2923
Practice Address - Country:US
Practice Address - Phone:931-647-0838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS81971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1223G0001XOtherTAXONOMY