Provider Demographics
NPI:1821172214
Name:LUPORI, JOHN PAUL (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:LUPORI
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 CENTRAL PARK DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8816
Mailing Address - Country:US
Mailing Address - Phone:970-871-0900
Mailing Address - Fax:970-871-0662
Practice Address - Street 1:940 CENTRAL PARK DR
Practice Address - Street 2:SUITE 106
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8816
Practice Address - Country:US
Practice Address - Phone:970-871-0900
Practice Address - Fax:970-871-0662
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO376011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17521840Medicaid
CO537708Medicare ID - Type Unspecified
CO17521840Medicaid