Provider Demographics
NPI:1740054741
Name:TIPPIT DENTAL GROUP LIVINGSTON
Entity type:Organization
Organization Name:TIPPIT DENTAL GROUP LIVINGSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPIT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-824-6424
Mailing Address - Street 1:9099 KATY FWY STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1632
Mailing Address - Country:US
Mailing Address - Phone:713-465-1860
Mailing Address - Fax:
Practice Address - Street 1:414 N TYLER AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-2956
Practice Address - Country:US
Practice Address - Phone:936-327-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty