Provider Demographics
NPI:1366465890
Name:LOPICCOLO, PHILLIP (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:LOPICCOLO
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 1:409 MAKIN AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-2936
Mailing Address - Country:US
Mailing Address - Phone:661-406-0881
Mailing Address - Fax:
Practice Address - Street 1:31 NIGHTINGALE ROAD BUILDING 5513
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CA
Practice Address - Zip Code:93524-2901
Practice Address - Country:US
Practice Address - Phone:661-277-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305091223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics