Healthcare Provider Details

I. General information

NPI: 1558772863
Provider Name (Legal Business Name): JAMES LIPON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415
US

IV. Provider business mailing address

4921 FREMONT AVE S
MINNEAPOLIS MN
55419-5210
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-3000
  • Fax: 612-659-4901
Mailing address:
  • Phone: 780-720-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13930
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number13930
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: