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General NPI Number Information
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NPI Number | 1013319771
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Entity Type | Organization
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Legal Business Name | VOLUSIA ENDODONTICS EAST, PA
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 1148 PELICAN BAY DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1381
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Country | US
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Telephone | 386-256-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 PELICAN BAY DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32119-1381
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. BRAD A LIPKIN
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Credential | D.D.S.
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Telephone | 386-256-2512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN16984
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License Number State | FL
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