Provider Demographics
NPI:1922212935
Name:LIPKOVITZ, MARK SAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:SAUL
Last Name:LIPKOVITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SOUTH VAN DIEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4625
Mailing Address - Country:US
Mailing Address - Phone:201-444-0683
Mailing Address - Fax:201-444-9980
Practice Address - Street 1:113 SOUTH VAN DIEN AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4625
Practice Address - Country:US
Practice Address - Phone:201-444-0683
Practice Address - Fax:201-444-9980
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01529400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist