Healthcare Provider Details

I. General information

NPI: 1558604488
Provider Name (Legal Business Name): JAMES M. LIPTON DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 CLINE AVE
HIGHLAND IN
46322-2204
US

IV. Provider business mailing address

9000 CLINE AVE
HIGHLAND IN
46322-2204
US

V. Phone/Fax

Practice location:
  • Phone: 219-923-2222
  • Fax: 219-923-2235
Mailing address:
  • Phone: 219-923-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12008215A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAMES M. LIPTON
Title or Position: OWNER
Credential: DDS
Phone: 219-923-2222