Provider Demographics
NPI:1871738732
Name:LIPMAN, DOUGLAS ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:LIPMAN
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 1:845 STATE ROUTE 17M
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1606
Mailing Address - Country:US
Mailing Address - Phone:845-782-8686
Mailing Address - Fax:845-783-8457
Practice Address - Street 1:845 STATE ROUTE 17M
Practice Address - Street 2:SUITE 201
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1606
Practice Address - Country:US
Practice Address - Phone:845-782-8686
Practice Address - Fax:845-783-8457
Is Sole Proprietor?:No
Enumeration Date:2008-12-07
Last Update Date:2008-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist