Provider Demographics
NPI:1417171042
Name:LIPPA, ELLEN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:C
Last Name:LIPPA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SHERRELWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1755
Mailing Address - Country:US
Mailing Address - Phone:716-688-2496
Mailing Address - Fax:
Practice Address - Street 1:2121 MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2693
Practice Address - Country:US
Practice Address - Phone:716-636-8686
Practice Address - Fax:716-832-0683
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0451431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice