Healthcare Provider Details

I. General information

NPI: 1326235904
Provider Name (Legal Business Name): LUCY J OPRIS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 12 MILE RD
BERKLEY MI
48072-1630
US

IV. Provider business mailing address

2790 12 MILE RD
BERKLEY MI
48072-1630
US

V. Phone/Fax

Practice location:
  • Phone: 248-439-0088
  • Fax: 248-439-2900
Mailing address:
  • Phone: 248-439-0088
  • Fax: 248-439-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number019027489
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901022416
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901022416
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: