Provider Demographics
NPI:1982721809
Name:SHIPP DENTAL CARE, LTD.
Entity Type:Organization
Organization Name:SHIPP DENTAL CARE, LTD.
Other - Org Name:MARY A. SHIPP, D.D.S., LTD.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-257-2921
Mailing Address - Street 1:11721 STINSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9542
Mailing Address - Country:US
Mailing Address - Phone:651-257-2921
Mailing Address - Fax:651-257-2921
Practice Address - Street 1:11721 STINSON AVE
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9542
Practice Address - Country:US
Practice Address - Phone:651-257-2921
Practice Address - Fax:651-257-2921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty