Provider Demographics
NPI:1205045804
Name:LIPETSKER, IRENE F (DMD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:F
Last Name:LIPETSKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 STONY BRAE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1727
Mailing Address - Country:US
Mailing Address - Phone:617-332-7093
Mailing Address - Fax:
Practice Address - Street 1:1247A BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5202
Practice Address - Country:US
Practice Address - Phone:617-566-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18213122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0275891Medicaid