Provider Demographics
NPI:1982884599
Name:BRYAN A. LIPSON, LTD, PC
Entity type:Organization
Organization Name:BRYAN A. LIPSON, LTD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-532-9303
Mailing Address - Street 1:18400 MAPLE CREEK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2976
Mailing Address - Country:US
Mailing Address - Phone:708-632-9303
Mailing Address - Fax:708-532-9324
Practice Address - Street 1:18400 MAPLE CREEK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2976
Practice Address - Country:US
Practice Address - Phone:708-632-9303
Practice Address - Fax:708-532-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental