Provider Demographics
NPI:1013937838
Name:SHIPON, STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:SHIPON
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 1:2226 S BROAD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3947
Mailing Address - Country:US
Mailing Address - Phone:215-334-5967
Mailing Address - Fax:215-334-5967
Practice Address - Street 1:2226 S BROAD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19145-3947
Practice Address - Country:US
Practice Address - Phone:215-334-5967
Practice Address - Fax:215-334-5967
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018011L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice