Provider Demographics
NPI:1699065169
Name:LUPU, MATTHEW SAMUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SAMUEL
Last Name:LUPU
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 1:7410 COQUINA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4023
Mailing Address - Country:US
Mailing Address - Phone:305-757-4173
Mailing Address - Fax:
Practice Address - Street 1:4011 WEST FLAGLER ST.
Practice Address - Street 2:SUITE #202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-541-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN192421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice