MEDICARE: ROCKY F. LUPARDUS, D.M.D., P.C.

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	261QD0000X	Dental Clinic/Center	DE 015475	MO

General Provider Information

NPI Number	:	1477758563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY F. LUPARDUS, D.M.D., P.C.

Provider Business Mailing Address
First Line	:	302 BALD HILL RD
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-3731
Country	:	US
Telephone Number	:	636-938-4450
Fax Number	:	636-938-1300

Provider Business Practice Location Address
First Line	:	302 BALD HILL RD
Second Line	:
City	:	EUREKA
State	:	MO
Zip	:	63025-3731
Country	:	US
Telephone Number	:	636-938-4450
Fax Number	:	636-938-1300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROCKY LUPARDUS
Credential	:	DMD
Telephone Number	:	636-938-4450

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	08/22/2020

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