Individual
SHAWN TIPPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
968 1ST INFANTRY DIVISION RD, FORT KNOX, KY 40121-5210
(502) 626-9303
Mailing address
398 192ND ARMORED TANK BN RD, FORT KNOX, KY 40121
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1002857
WI
1223G0001X
General Practice Dentistry
1002857
WI
Other
Enumeration date
07/21/2021
Last updated
03/08/2023
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