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General NPI Number Information
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NPI Number | 1326204009
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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 | 08/01/2008
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Last Update Date | 06/21/2014
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Provider Practice Location Address
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Address Line | 605 STANDIFORD AVE SUITE H
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City | MODESTO
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State | CA
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Zip | 95350-1000
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Country | US
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Telephone | 209-527-1995
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Fax | 877-641-2283
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Provider Business Mailing Address
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Address Line | 26626 BROOKS CIR
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City | STEVENSON RANCH
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State | CA
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Zip | 91381-1459
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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 R LIPSEY
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Credential | DDS MS
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Telephone | 209-527-1995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 26675
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License Number State | CA
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