Provider Demographics
NPI:1356455877
Name:LIPTON, CHARLES RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:LIPTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 63RD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7466
Mailing Address - Country:US
Mailing Address - Phone:212-838-6226
Mailing Address - Fax:212-838-0352
Practice Address - Street 1:245 E 63RD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7466
Practice Address - Country:US
Practice Address - Phone:212-838-6226
Practice Address - Fax:212-838-0352
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0283091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice