Provider Demographics
NPI:1104809086
Name:LIPP, CHARLES TIMOTHY (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:TIMOTHY
Last Name:LIPP
Suffix:
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 1:800 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010
Mailing Address - Country:US
Mailing Address - Phone:724-846-9690
Mailing Address - Fax:
Practice Address - Street 1:3315 4TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010
Practice Address - Country:US
Practice Address - Phone:724-843-7088
Practice Address - Fax:724-843-7088
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025760L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BL1012462OtherDEA