Healthcare Provider Details

I. General information

NPI: 1982669941
Provider Name (Legal Business Name): RONALD L LIPP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 MAIN ST
NEW MIDDLETOWN OH
44442
US

IV. Provider business mailing address

PO BOX 487 10309 MAIN ST
NEW MIDDLETOWN OH
44442-0487
US

V. Phone/Fax

Practice location:
  • Phone: 330-542-9812
  • Fax: 330-542-9812
Mailing address:
  • Phone: 330-542-9812
  • Fax: 330-542-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16828
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: