Provider Demographics
NPI:1891986857
Name:JASON T LIPSCOMB DDS P C
Entity Type:Organization
Organization Name:JASON T LIPSCOMB DDS P C
Other - Org Name:JASON T. LIPSCOMB D.D.S. P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-373-1641
Mailing Address - Street 1:200 EXECUTIVE CENTER PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3177
Mailing Address - Country:US
Mailing Address - Phone:540-373-1641
Mailing Address - Fax:
Practice Address - Street 1:200 EXECUTIVE CENTER PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3177
Practice Address - Country:US
Practice Address - Phone:540-373-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty