Provider Demographics
NPI:1487666053
Name:LUPSA, RADU MYRON (DDS)
Entity Type:Individual
Prefix:
First Name:RADU
Middle Name:MYRON
Last Name:LUPSA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MYRON
Other - Middle Name:RADU
Other - Last Name:LUPSA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:16 SKYLINE LAKES DR
Mailing Address - Street 2:STE #8
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456
Mailing Address - Country:US
Mailing Address - Phone:973-839-3434
Mailing Address - Fax:973-839-1366
Practice Address - Street 1:16 SKYLINE LAKES DR
Practice Address - Street 2:STE #8
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456
Practice Address - Country:US
Practice Address - Phone:973-839-3434
Practice Address - Fax:973-839-1366
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101896100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist