Provider Demographics
NPI:1801988324
Name:TIPTON, STANLEY (DDS)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:TIPTON
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 1:442 W HIGH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1681
Mailing Address - Country:US
Mailing Address - Phone:419-636-3163
Mailing Address - Fax:419-636-5037
Practice Address - Street 1:442 W HIGH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1681
Practice Address - Country:US
Practice Address - Phone:419-636-3163
Practice Address - Fax:419-636-5037
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300153031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH885522OtherSTANLEY TIPTON - UCCI
OH30015303OtherSTANLEY TIPTON-DELTAL DEN
OH0320030Medicaid