Provider Demographics
NPI:1073621769
Name:LIPSCHITZ, WAYNE STANLEY (DDS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:STANLEY
Last Name:LIPSCHITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CLINTON AVE S
Mailing Address - Street 2:BOX 705
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2668
Mailing Address - Country:US
Mailing Address - Phone:585-371-7177
Mailing Address - Fax:585-276-0293
Practice Address - Street 1:2400 CLINTON AVE S
Practice Address - Street 2:BOX 705
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2668
Practice Address - Country:US
Practice Address - Phone:585-371-7177
Practice Address - Fax:585-276-0293
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY462071223G0001X
NY0462071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
70078OtherBLUE SHIELD GROUP NUMBER
NY01732750Medicaid
NY01732750Medicaid