Provider Demographics
NPI:1558604488
Name:JAMES M. LIPTON DDS PC
Entity Type:Organization
Organization Name:JAMES M. LIPTON DDS PC
Other - Org Name:JAMES M. LIPTON DDS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-923-2222
Mailing Address - Street 1:9000 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2204
Mailing Address - Country:US
Mailing Address - Phone:219-923-2222
Mailing Address - Fax:
Practice Address - Street 1:9000 CLINE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2204
Practice Address - Country:US
Practice Address - Phone:219-923-2222
Practice Address - Fax:219-923-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008215A122300000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558604488OtherORGANIZATIONAL NPI