Provider Demographics
NPI:1902930241
Name:LOPP, MATTHEW B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:B
Last Name:LOPP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24702 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4908
Mailing Address - Country:US
Mailing Address - Phone:346-236-7474
Mailing Address - Fax:
Practice Address - Street 1:28527 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4545
Practice Address - Country:US
Practice Address - Phone:713-623-1122
Practice Address - Fax:281-907-8003
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY80741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-5079293OtherTAX ID #, EMPLOYER ID #
TX218802100Medicaid