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General NPI Number Information
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NPI Number | 1982884599
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Entity Type | Organization
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Legal Business Name | BRYAN A. LIPSON, LTD, PC
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 18400 MAPLE CREEK DR SUITE 100
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City | TINLEY PARK
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State | IL
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Zip | 60477-2976
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Country | US
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Telephone | 708-632-9303
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Fax | 708-532-9324
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Provider Business Mailing Address
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Address Line | 18400 MAPLE CREEK DR SUITE 100
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City | TINLEY PARK
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State | IL
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Zip | 60477-2976
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Country | US
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Telephone | 708-632-9303
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Fax | 708-532-9324
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRYAN A. LIPSON
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Credential | DDS
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Telephone | 708-532-9303
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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 |
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License Number State | IL
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