Provider Demographics
NPI:1558426932
Name:LIPOSKY, RICHARD B (ORAL MAXILLOFACIAL)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:LIPOSKY
Suffix:
Gender:M
Credentials:ORAL MAXILLOFACIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 POWERS FERRY RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9412
Mailing Address - Country:US
Mailing Address - Phone:770-980-9860
Mailing Address - Fax:
Practice Address - Street 1:1545 POWERS FERRY RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-9412
Practice Address - Country:US
Practice Address - Phone:770-980-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPDN0000021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery