Provider Demographics
NPI:1376528232
Name:LIPPERT, DOUGLAS R (DMD, FAGD, DABDSM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:LIPPERT
Suffix:
Gender:M
Credentials:DMD, FAGD, DABDSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1352
Mailing Address - Country:US
Mailing Address - Phone:724-863-5700
Mailing Address - Fax:724-863-5701
Practice Address - Street 1:12814 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-1352
Practice Address - Country:US
Practice Address - Phone:724-863-5700
Practice Address - Fax:724-863-5701
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0357011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice