Provider Demographics
NPI:1275799546
Name:TIMOTHY R LIPTAK DMD & ASSOCIATES LLC
Entity Type:Organization
Organization Name:TIMOTHY R LIPTAK DMD & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LIPTAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-577-6376
Mailing Address - Street 1:114 1/2 ASHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1143
Mailing Address - Country:US
Mailing Address - Phone:843-577-6376
Mailing Address - Fax:
Practice Address - Street 1:114 1/2 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1143
Practice Address - Country:US
Practice Address - Phone:843-577-6376
Practice Address - Fax:843-722-1653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty