Provider Demographics
NPI:1881896793
Name:POPKOFF, LISA B (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:POPKOFF
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 1:10920 DELCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1705
Mailing Address - Country:US
Mailing Address - Phone:818-882-3237
Mailing Address - Fax:818-882-8362
Practice Address - Street 1:1755 ERRINGER RD
Practice Address - Street 2:SUITE 10
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6507
Practice Address - Country:US
Practice Address - Phone:818-268-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist