Active NPI
Derren Elvis Tippets, DMD
- Pediatric Dentistry
- Montrose, CO
National Provider Identifier
1306003777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 9579
- Practice address
- 100 Tessitore CT
Suite C
Montrose, CO 81401-5689 - Phone
- (856) 206-2164
- NPI assigned
- May 21, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 9579 | CO | Primary |
Addresses
Primary practice location
100 Tessitore CT
Suite C
Montrose, CO 81401-5689
Mailing address
100 Tessitore CT
Suite C
Montrose, CO 81401-5689
Phone (856) 206-2164
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9579 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211328000000",
"number": "1306003777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 TESSITORE CT",
"address_2": "SUITE C",
"city": "MONTROSE",
"state": "CO",
"postal_code": "814015689",
"telephone_number": "856-206-2164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 TESSITORE CT",
"address_2": "SUITE C",
"city": "MONTROSE",
"state": "CO",
"postal_code": "814015689",
"telephone_number": "856-206-2164"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIPPETS",
"first_name": "DERREN",
"middle_name": "ELVIS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-21",
"last_updated": "2008-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CO",
"license": "9579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montrose, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.