Provider Demographics
NPI:1073819520
Name:IRWIN FAMILY DENTAL, LLC
Entity type:Organization
Organization Name:IRWIN FAMILY DENTAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:LIPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, FAGD, DABDSM
Authorized Official - Phone:724-863-5700
Mailing Address - Street 1:12814 STATE ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-1352
Mailing Address - Country:US
Mailing Address - Phone:724-863-5700
Mailing Address - Fax:724-863-5701
Practice Address - Street 1:12814 STATE ROUTE 30
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-1352
Practice Address - Country:US
Practice Address - Phone:724-863-5700
Practice Address - Fax:724-863-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO357011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty