Provider Demographics
NPI:1275223521
Name:LUPINI, JACOB DANTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DANTE
Last Name:LUPINI
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 1:15794 GARRISON LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2639
Mailing Address - Country:US
Mailing Address - Phone:517-993-3269
Mailing Address - Fax:
Practice Address - Street 1:1680 KINGSWAY CT STE 1
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-1957
Practice Address - Country:US
Practice Address - Phone:734-675-2510
Practice Address - Fax:734-675-7130
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016017711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice