Healthcare Provider Details

I. General information

NPI: 1992974133
Provider Name (Legal Business Name): MICHAEL LIPSON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

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

11438 LEBONON ROAD SUITE C
SHARONVILLE OH
45241
US

IV. Provider business mailing address

11438 LEBONON ROAD SUITE C
SHARONVILLE OH
45241
US

V. Phone/Fax

Practice location:
  • Phone: 513-563-6611
  • Fax: 513-563-4107
Mailing address:
  • Phone: 513-563-6611
  • Fax: 513-563-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number6049
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number15034
License Number StateOH

VIII. Authorized Official

Name: DR. MICHAEL LIPSON
Title or Position: OWNER
Credential: DDS
Phone: 513-563-6611