Provider Demographics
NPI:1366573222
Name:MARK D. PHIPPS DDS
Entity type:Organization
Organization Name:MARK D. PHIPPS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-885-0697
Mailing Address - Street 1:161 PALM AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3718
Mailing Address - Country:US
Mailing Address - Phone:530-885-0697
Mailing Address - Fax:530-889-5697
Practice Address - Street 1:161 PALM AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3718
Practice Address - Country:US
Practice Address - Phone:530-885-0697
Practice Address - Fax:530-889-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588795249OtherUNDEFINED PHYSICIAN (GENERAL DENTIST)