Provider Demographics
NPI:1629261409
Name:LIPSCOMB, LAUREEN RITA (RDH)
Entity Type:Individual
Prefix:
First Name:LAUREEN
Middle Name:RITA
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-0200
Mailing Address - Country:US
Mailing Address - Phone:304-535-2409
Mailing Address - Fax:304-535-2408
Practice Address - Street 1:1200 WASHUINGTON ST
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425
Practice Address - Country:US
Practice Address - Phone:304-535-2409
Practice Address - Fax:304-535-2408
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1995124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist