MEDICARE: DR. MITCHELL S LIPPMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7345	GA

General Provider Information

NPI Number	:	1063548261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL S LIPPMAN D.D.S.

Provider Business Mailing Address
First Line	:	1295 TERRELL MILL RD SE
Second Line	:	SUITE 101
City	:	MARIETTA
State	:	GA
Zip	:	30067-9438
Country	:	US
Telephone Number	:	770-952-4152
Fax Number	:	770-952-4007

Provider Business Practice Location Address
First Line	:	1295 TERRELL MILL RD SE
Second Line	:	SUITE 101
City	:	MARIETTA
State	:	GA
Zip	:	30067-9438
Country	:	US
Telephone Number	:	770-952-4152
Fax Number	:	770-952-4007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2007
Last Update Date	:	07/08/2007

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