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General NPI Number Information
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NPI Number | 1073875852
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Entity Type | Organization
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Legal Business Name | MARTY R. LIPSEY, DDS, MS, INC
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 2421 HARTNELL AVE
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City | REDDING
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State | CA
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Zip | 96002-2340
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Country | US
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Telephone | 209-527-1995
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Fax | 866-527-2335
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Provider Business Mailing Address
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Address Line | 3025 MCHENRY AVE SUITE N
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City | MODESTO
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State | CA
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Zip | 95350-1466
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Country | US
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Telephone | 209-527-1995
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Fax | 866-527-2335
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTY RICHARD LIPSEY
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Credential | D.D.S., M.S.
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Telephone | 209-380-5486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 26675
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License Number State | CA
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