Provider Demographics
NPI:1891854972
Name:LIPPOLD, CHRIS
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:
Last Name:LIPPOLD
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:LIPPOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4843 S 24TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-2704
Mailing Address - Country:US
Mailing Address - Phone:402-731-0388
Mailing Address - Fax:
Practice Address - Street 1:4843 S 24TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-2704
Practice Address - Country:US
Practice Address - Phone:402-731-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0560516Medicaid