Provider Demographics
NPI:1730282799
Name:LEPINGWELL, JOHN GORDON JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GORDON
Last Name:LEPINGWELL
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2310
Mailing Address - Country:US
Mailing Address - Phone:617-889-1990
Mailing Address - Fax:617-889-1991
Practice Address - Street 1:131 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2310
Practice Address - Country:US
Practice Address - Phone:617-889-1990
Practice Address - Fax:617-889-1991
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX07667OtherBLUE CROSS BLUE SHIELD
MA0280429Medicare ID - Type Unspecified