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General NPI Number Information
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NPI Number | 1528448172
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Entity Type | Individual
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Provider Name | ELICIA LUPOLI RDH
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 54 MEADOW ST FL 3
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City | NEW HAVEN
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State | CT
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Zip | 06519-1719
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Country | US
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Telephone | 475-220-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 8 JEFFERSON ST
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City | SEYMOUR
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State | CT
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Zip | 06483-2110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 006598
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License Number State | CT
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