Provider Demographics
NPI:1558772863
Name:LIPON, JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:LIPON
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 1:4921 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5210
Mailing Address - Country:US
Mailing Address - Phone:780-720-5370
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-3000
Practice Address - Fax:612-659-4901
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN139301223P0221X, 1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No1223P0221XDental ProvidersDentistPediatric Dentistry