Provider Demographics
NPI:1093735862
Name:LIPPARD, HAL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:M
Last Name:LIPPARD
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 1:505 FAULCONER DR
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4981
Mailing Address - Country:US
Mailing Address - Phone:434-293-9311
Mailing Address - Fax:434-293-2105
Practice Address - Street 1:505 FAULCONER DR
Practice Address - Street 2:SUITE 1D
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4981
Practice Address - Country:US
Practice Address - Phone:434-293-9311
Practice Address - Fax:434-293-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010051111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice