Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 13930 | MN |
N | 1223P0221X | Pediatric Dentist | 13930 | MN |
NPI | 1558772863 |
---|---|
Provider Name | Dr. James Lipon |
First Address | Minneapolis, MN 55419-5210 |
Second Address | Minneapolis, MN 55415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 12/06/2018 |