Provider Demographics
NPI:1982616694
Name:TIPTON, WALTER STUART (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:STUART
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 1:1205 GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2759
Mailing Address - Country:US
Mailing Address - Phone:865-475-8988
Mailing Address - Fax:
Practice Address - Street 1:1205 GEORGE AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2759
Practice Address - Country:US
Practice Address - Phone:865-475-8988
Practice Address - Fax:865-475-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000031871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice