MEDICARE: PETER LOPATIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02648000	NJ
2	122300000X	Dentist	DN22172	FL
3	122300000X	Dentist	11673	CT

General Provider Information

NPI Number	:	1164976213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER LOPATIN

Provider Business Mailing Address
First Line	:	12875 ELMFORD LN
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 MALL DR W
Second Line	:	NEWPORT CENTRE DENTAL
City	:	JERSEY CITY
State	:	NJ
Zip	:	07310-1615
Country	:	US
Telephone Number	:	201-626-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2016
Last Update Date	:	12/11/2016

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Directions to “ PETER LOPATIN ” Practice Location

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