Provider Demographics
NPI:1730199035
Name:LISA LOPATIN DDS PC
Entity type:Organization
Organization Name:LISA LOPATIN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:LOPATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-362-5055
Mailing Address - Street 1:2265 LIVERNOIS
Mailing Address - Street 2:SUITE 406
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083
Mailing Address - Country:US
Mailing Address - Phone:248-362-5055
Mailing Address - Fax:248-362-5056
Practice Address - Street 1:2265 LIVERNOIS
Practice Address - Street 2:SUITE 406
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-362-5055
Practice Address - Fax:248-362-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13776122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty