Individual provider Active NPI

William Edward Lippisch, D.M.D., P.A.

  • Oral and Maxillofacial Surgery (Dentist)
  • Stuart, FL
National Provider Identifier
1952337768
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
DN0009379 Issued in FL
Practice address
841 E Ocean Blvd
Stuart, FL 34994-2427
Phone
(772) 223-0600
Fax
(772) 223-0617
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X DN0009379 FL Primary

Addresses

Primary practice location

841 E Ocean Blvd
Stuart, FL 34994-2427

Mailing address

18 Riverview Dr
Stuart, FL 34996-6315
Phone (772) 223-0600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121009000528 FL Practitioner - Maxillofacial Surgery 8123277076

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
DN0009379FLMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Shawn T Engebretsen DMD P a Oral and Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1952337768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 RIVERVIEW DR",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349966315",
            "telephone_number": "772-223-0600",
            "fax_number": "772-223-0617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "841 E OCEAN BLVD",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942427",
            "telephone_number": "772-223-0600",
            "fax_number": "772-223-0617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPPISCH",
        "first_name": "WILLIAM",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "D.M.D., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN0009379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stuart, FL

Sources for this page

Verify at the official NPI Registry.