Provider Demographics
NPI:1841248366
Name:LOPICCOLO, LISA M (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:LOPICCOLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20607 E 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1401
Mailing Address - Country:US
Mailing Address - Phone:586-778-4111
Mailing Address - Fax:586-775-7692
Practice Address - Street 1:20607 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1401
Practice Address - Country:US
Practice Address - Phone:586-778-4111
Practice Address - Fax:586-775-7692
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI164151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice