Provider Demographics
NPI:1538172010
Name:SIPPY, DAVID DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEAN
Last Name:SIPPY
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:N8588 ZENTNER RD
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-8881
Mailing Address - Country:US
Mailing Address - Phone:608-527-2121
Mailing Address - Fax:608-930-3031
Practice Address - Street 1:119 6TH AVE
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574
Practice Address - Country:US
Practice Address - Phone:608-527-2121
Practice Address - Fax:608-930-3031
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33680100Medicaid