Provider Demographics
NPI:1851626691
Name:LIPPINCOTT, GARY
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:LIPPINCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 S CONSTITUTION DR
Mailing Address - Street 2:102
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-7341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 S CONSTITUTION DR
Practice Address - Street 2:102
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-7341
Practice Address - Country:US
Practice Address - Phone:630-896-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210013871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics