Provider Demographics
NPI:1629087671
Name:IRA S LAPIDUS DMD PC
Entity Type:Organization
Organization Name:IRA S LAPIDUS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LAPIDUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-458-4238
Mailing Address - Street 1:182 ADAMS ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267
Mailing Address - Country:US
Mailing Address - Phone:413-458-4238
Mailing Address - Fax:413-458-9321
Practice Address - Street 1:182 ADAMS ROAD
Practice Address - Street 2:
Practice Address - City:WILLAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267
Practice Address - Country:US
Practice Address - Phone:413-458-4238
Practice Address - Fax:413-458-9321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA115061223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1000446OtherMEDICAL
MA0221333Medicaid