Provider Demographics
NPI:1306849302
Name:LUPARDUS, ROCKY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROCKY
Middle Name:
Last Name:LUPARDUS
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 1:302 BALD HILL RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-3731
Mailing Address - Country:US
Mailing Address - Phone:636-938-4450
Mailing Address - Fax:636-938-1300
Practice Address - Street 1:302 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3731
Practice Address - Country:US
Practice Address - Phone:636-938-4450
Practice Address - Fax:636-938-1300
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE 0154751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice