Tyler Keith Lipham, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015668 Issued in GA

Practice address

458 W Washington St
Monticello, GA 31064-1368

Phone

(706) 468-6394

Fax

(706) 468-8113

NPI assigned

Jun 24, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Monticello Family Dentistry

  • General Practice Dentistry
  • Monticello, GA
  • NPI 1679340368
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1821583782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 DELL AVE",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306063406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 W WASHINGTON ST",
            "city": "MONTICELLO",
            "state": "GA",
            "postal_code": "310641368",
            "telephone_number": "706-468-6394",
            "fax_number": "706-468-8113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPHAM",
        "first_name": "TYLER",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-24",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ruby Catherine Jenkins, M.A.
• Jarvis Johnson
• Lyndsy Holman Johnston, D.C.
• Nataliya Kubasova, MD
• David Keith Leach, PHARM. D.
• Lovely Living Personal Care Home
• Caroline Marlin, DMD
• Mesepp Community, Inc
• Lyudmila Mishelevich, M.D.
• Jamie Alan Mitchell, DMD

• General Practice Dentistry in Monticello, GA
• Providers in Monticello, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.