Provider Demographics
NPI:1740268283
Name:LIPSCOMB, RICHARD M (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-656-3486
Mailing Address - Fax:724-598-7337
Practice Address - Street 1:2807 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1263
Practice Address - Country:US
Practice Address - Phone:724-656-3486
Practice Address - Fax:724-598-7337
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018761L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005110100007Medicaid
OH0784736Medicaid
PA005110100005Medicaid
PA005110100008Medicaid