Provider Demographics
NPI:1407944150
Name:D. GREGORY LOPOUR DDS, SMILES BY DESIGN, PA
Entity Type:Organization
Organization Name:D. GREGORY LOPOUR DDS, SMILES BY DESIGN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:LOPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-298-7475
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM19961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty