Provider Demographics
NPI:1447310891
Name:LIPSON, MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LIPSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:LIPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11438 LEBANON ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241
Mailing Address - Country:US
Mailing Address - Phone:513-563-6611
Mailing Address - Fax:513-563-4107
Practice Address - Street 1:11438 LEBANON ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-563-6611
Practice Address - Fax:513-563-4107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015034122300000X
FL6049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist