Provider Demographics
NPI:1730226119
Name:SHIPLEY, CAROL ANN (DDS MPH)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:SHIPLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS MPH
Mailing Address - Street 1:140 DAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-6413
Mailing Address - Country:US
Mailing Address - Phone:865-215-5110
Mailing Address - Fax:865-215-5117
Practice Address - Street 1:140 DAMERON AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-6413
Practice Address - Country:US
Practice Address - Phone:865-215-5110
Practice Address - Fax:865-215-5117
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN255301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3205464Medicaid