Provider Demographics
NPI:1154463966
Name:LIPELT, MICHAEL JON (DDS, ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JON
Last Name:LIPELT
Suffix:
Gender:M
Credentials:DDS, ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4262
Mailing Address - Country:US
Mailing Address - Phone:707-829-2737
Mailing Address - Fax:707-829-2736
Practice Address - Street 1:523 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4262
Practice Address - Country:US
Practice Address - Phone:707-829-2737
Practice Address - Fax:707-829-2736
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25168122300000X
CA5172171100000X
CA151175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath