Provider Demographics
NPI:1700889706
Name:LIPSEY, MARTY RICHARD (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARTY
Middle Name:RICHARD
Last Name:LIPSEY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 MCHENRY AVE
Mailing Address - Street 2:STE N
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1449
Mailing Address - Country:US
Mailing Address - Phone:209-527-3990
Mailing Address - Fax:
Practice Address - Street 1:3025 MCHENRY AVE
Practice Address - Street 2:STE N
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1449
Practice Address - Country:US
Practice Address - Phone:209-527-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266751223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics