Healthcare Provider Details

I. General information

NPI: 1487666053
Provider Name (Legal Business Name): RADU MYRON LUPSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MYRON RADU LUPSA DDS

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 SKYLINE LAKES DR STE #8
RINGWOOD NJ
07456
US

IV. Provider business mailing address

16 SKYLINE LAKES DR STE #8
RINGWOOD NJ
07456
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-3434
  • Fax: 973-839-1366
Mailing address:
  • Phone: 973-839-3434
  • Fax: 973-839-1366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22D101896100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: