Provider Demographics
NPI:1811042138
Name:LAPIDUS, DANIEL ETHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ETHAN
Last Name:LAPIDUS
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 1:3933 CARISSA CT
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7417
Mailing Address - Country:US
Mailing Address - Phone:805-540-0425
Mailing Address - Fax:
Practice Address - Street 1:1551 BISHOP ST STE 420
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4663
Practice Address - Country:US
Practice Address - Phone:805-543-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7075122300000X
CA57039122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist