Provider Demographics
NPI:1164554861
Name:LOPOUR, DAVID GREGORY (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREGORY
Last Name:LOPOUR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 MASTHEAD ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4412
Mailing Address - Country:US
Mailing Address - Phone:505-298-7475
Mailing Address - Fax:505-323-0997
Practice Address - Street 1:5110 MASTHEAD ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4412
Practice Address - Country:US
Practice Address - Phone:505-298-7475
Practice Address - Fax:505-323-0997
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice