Provider Demographics
NPI:1437238599
Name:LIPSCOMB, JASON TODD (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:TODD
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 EXECUTIVE CENTER PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3177
Mailing Address - Country:US
Mailing Address - Phone:540-373-1641
Mailing Address - Fax:
Practice Address - Street 1:200 EXECUTIVE CENTER PKWY
Practice Address - Street 2:SUITE #104
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3177
Practice Address - Country:US
Practice Address - Phone:540-373-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice