Provider Demographics
NPI:1679728257
Name:LUPERON, PRISCILA (DMD)
Entity type:Individual
Prefix:
First Name:PRISCILA
Middle Name:
Last Name:LUPERON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 CENTRAL PKWY E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-5551
Mailing Address - Country:US
Mailing Address - Phone:972-633-2775
Mailing Address - Fax:469-361-4700
Practice Address - Street 1:4400 LITTLE ROAD
Practice Address - Street 2:SUITE 331
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016
Practice Address - Country:US
Practice Address - Phone:972-578-7800
Practice Address - Fax:469-361-4700
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics