Provider Demographics
NPI:1700839024
Name:LIPOFF, JASON A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:LIPOFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9523 US HIGHWAY 42 UNIT 1004
Mailing Address - Street 2:APT 1530
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-5040
Mailing Address - Country:US
Mailing Address - Phone:847-502-7574
Mailing Address - Fax:866-477-5326
Practice Address - Street 1:9523 US HIGHWAY 42 UNIT 1004
Practice Address - Street 2:APT 1530
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-5040
Practice Address - Country:US
Practice Address - Phone:847-502-7574
Practice Address - Fax:866-477-5326
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL19026157122300000X
FLDN187721223P0221X
KY82631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist