Healthcare Provider Details

I. General information

NPI: 1205005428
Provider Name (Legal Business Name): IRA STEVEN LAPIDUS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 ADAMS ROAD
WILLIAMSTOWN MA
01267
US

IV. Provider business mailing address

182 ADAMS ROAD
WILLIAMSTOWN MA
01267
US

V. Phone/Fax

Practice location:
  • Phone: 413-458-4238
  • Fax: 413-458-9321
Mailing address:
  • Phone: 413-458-4238
  • Fax: 413-458-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number11506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: