Provider Demographics
NPI:1639383698
Name:LOPP, CLARENCE LEE II (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:LEE
Last Name:LOPP
Suffix:II
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 1:803 SOUTH PRAIRIE STREET
Mailing Address - Street 2:P.O. BOX 158
Mailing Address - City:BROOKSTON
Mailing Address - State:IN
Mailing Address - Zip Code:47923-8410
Mailing Address - Country:US
Mailing Address - Phone:765-563-3636
Mailing Address - Fax:765-563-2020
Practice Address - Street 1:803 S. PRAIRIE ST.
Practice Address - Street 2:
Practice Address - City:BROOKSTON
Practice Address - State:IN
Practice Address - Zip Code:47923-8410
Practice Address - Country:US
Practice Address - Phone:765-563-3636
Practice Address - Fax:765-563-2020
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN76301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice