Provider Demographics
NPI:1730616897
Name:TIPTON, CARLY MORGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:MORGAN
Last Name:TIPTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 W ELK AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3787
Mailing Address - Country:US
Mailing Address - Phone:423-543-2755
Mailing Address - Fax:423-543-7717
Practice Address - Street 1:1975 W ELK AVE STE 2
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3787
Practice Address - Country:US
Practice Address - Phone:423-543-2755
Practice Address - Fax:423-543-7717
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9924122300000X
TN104741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist