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General NPI Number Information
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NPI Number | 1275799546
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Entity Type | Organization
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Legal Business Name | TIMOTHY R LIPTAK DMD & ASSOCIATES LLC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/23/2010
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Provider Practice Location Address
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Address Line | 114 1/2 ASHLEY AVE
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City | CHARLESTON
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State | SC
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Zip | 29401-1143
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Country | US
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Telephone | 843-577-6376
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Fax | 843-722-1653
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Provider Business Mailing Address
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Address Line | 114 1/2 ASHLEY AVE
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City | CHARLESTON
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State | SC
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Zip | 29401-1143
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Country | US
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Telephone | 843-577-6376
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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. TIMOTHY ROBERT LIPTAK
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Credential | DMD
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Telephone | 843-577-6376
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4299
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License Number State | SC
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