Healthcare Provider Details

I. General information

NPI: 1073621769
Provider Name (Legal Business Name): WAYNE STANLEY LIPSCHITZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CLINTON AVE S BOX 705
ROCHESTER NY
14618-2668
US

IV. Provider business mailing address

2400 CLINTON AVE S BOX 705
ROCHESTER NY
14618-2668
US

V. Phone/Fax

Practice location:
  • Phone: 585-371-7177
  • Fax: 585-276-0293
Mailing address:
  • Phone: 585-371-7177
  • Fax: 585-276-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46207
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number046207
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: