Provider Demographics
NPI:1093725392
Name:LOPATIN, LISA GAYLE (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:LOPATIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 LIVERNOIS
Mailing Address - Street 2:SUITE 406
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-362-5055
Mailing Address - Fax:248-362-5056
Practice Address - Street 1:2265 LIVERNOIS
Practice Address - Street 2:SUITE 406
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-362-5055
Practice Address - Fax:248-362-5056
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist