Provider Demographics
NPI:1700839024
Name:LIPOFF, JASON A (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:LIPOFF
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 1:10510 MEETING ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-5516
Mailing Address - Country:US
Mailing Address - Phone:847-502-7574
Mailing Address - Fax:502-230-2131
Practice Address - Street 1:10510 MEETING ST UNIT 101
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-5516
Practice Address - Country:US
Practice Address - Phone:847-502-7574
Practice Address - Fax:502-230-2131
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187721223P0221X
IL19026157122300000X
KY82631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist