Provider Demographics
NPI:1326204009
Name:MARTY R LIPSEY DDS MS INC
Entity Type:Organization
Organization Name:MARTY R LIPSEY DDS MS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:209-527-1995
Mailing Address - Street 1:26626 BROOKS CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1459
Mailing Address - Country:US
Mailing Address - Phone:209-527-1995
Mailing Address - Fax:866-527-2335
Practice Address - Street 1:605 STANDIFORD AVE
Practice Address - Street 2:SUITE H
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1000
Practice Address - Country:US
Practice Address - Phone:209-527-1995
Practice Address - Fax:877-641-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty