Individual
EVAN SHIPP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(512) 621-5529
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
61852
CA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
35986
TX
Other
Enumeration date
05/24/2012
Last updated
07/22/2020
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