Provider Demographics
NPI:1487882551
Name:LIPPS, GERALD A (DDS)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:LIPPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3003
Mailing Address - Country:US
Mailing Address - Phone:301-230-2888
Mailing Address - Fax:301-230-9121
Practice Address - Street 1:11300 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 1109
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3003
Practice Address - Country:US
Practice Address - Phone:301-230-2888
Practice Address - Fax:301-230-9121
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD67011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice