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General NPI Number Information
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NPI Number | 1114290988
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Entity Type | Organization
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Legal Business Name | ST. CHARLES FAMILY DENTRISTRY L.T.D.
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 516 E MAIN ST
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City | ST CHARLES
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State | IL
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Zip | 60174-2133
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Country | US
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Telephone | 630-377-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 516 E MAIN ST
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City | ST CHARLES
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State | IL
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Zip | 60174-2133
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Country | US
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Telephone | 630-377-3131
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDMUND A LIPSKIS
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Credential | D.D.S.
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Telephone | 630-377-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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