Provider Demographics
NPI:1689990228
Name:LIPPERT, DYLAN COREY (MD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:COREY
Last Name:LIPPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N. WASHINGTON AVE., STE 7000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246
Mailing Address - Country:US
Mailing Address - Phone:214-826-3681
Mailing Address - Fax:214-826-7277
Practice Address - Street 1:411 N. WASHINGTON AVE., STE 7000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246
Practice Address - Country:US
Practice Address - Phone:214-826-3681
Practice Address - Fax:214-826-7277
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49956207Y00000X
TXQ8286207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1976706-01Medicaid