Provider Demographics
NPI:1174582449
Name:SHIPMAN, GREGORY LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:SHIPMAN
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:PO BOX 1640
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-1640
Mailing Address - Country:US
Mailing Address - Phone:520-249-9879
Mailing Address - Fax:
Practice Address - Street 1:2240 E. WINROW AVE
Practice Address - Street 2:US ARMY DENTAL CLINIC COMMAND
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-7040
Practice Address - Country:US
Practice Address - Phone:520-533-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist