Provider Demographics
NPI:1619095452
Name:LIPSCOMB, RICHARD MARVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARVIN
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11721 WOODMORE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4117
Mailing Address - Country:US
Mailing Address - Phone:301-430-0934
Mailing Address - Fax:301-430-0936
Practice Address - Street 1:11721 WOODMORE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-4117
Practice Address - Country:US
Practice Address - Phone:301-430-0934
Practice Address - Fax:301-430-0936
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice