Provider Demographics
NPI:1053470112
Name:LIPPITZ, STEPHEN J
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:LIPPITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 EUCLID AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-7212
Mailing Address - Country:US
Mailing Address - Phone:847-397-1111
Mailing Address - Fax:847-397-1142
Practice Address - Street 1:4949 EUCLID AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-7212
Practice Address - Country:US
Practice Address - Phone:847-397-1111
Practice Address - Fax:847-397-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics