MEDICARE: DR. RICHARD MARVIN LIPSCOMB DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11783	MD

General Provider Information

NPI Number	:	1619095452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD MARVIN LIPSCOMB DDS

Provider Business Mailing Address
First Line	:	11721 WOODMORE RD
Second Line	:	SUITE 150
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-4117
Country	:	US
Telephone Number	:	301-430-0934
Fax Number	:	301-430-0936

Provider Business Practice Location Address
First Line	:	11721 WOODMORE RD
Second Line	:	SUITE 150
City	:	MITCHELLVILLE
State	:	MD
Zip	:	20721-4117
Country	:	US
Telephone Number	:	301-430-0934
Fax Number	:	301-430-0936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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