Provider Demographics
NPI:1326235904
Name:OPRIS, LUCY J (DDS)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:J
Last Name:OPRIS
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 1:2790 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1630
Mailing Address - Country:US
Mailing Address - Phone:248-439-0088
Mailing Address - Fax:248-439-2900
Practice Address - Street 1:2790 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1630
Practice Address - Country:US
Practice Address - Phone:248-439-0088
Practice Address - Fax:248-439-2900
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190274891223D0001X
MI29010224161223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20170171OtherMOBILE DENTAL PERMIT
MIPA161OtherPA161
MI1780096792OtherTYPE 2 NPI
MI13501447OtherCAQH