MEDICARE: DR. ROCKY LUPARDUS D.M.D.

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	1223G0001X	General Practice Dentistry	DE 015475	MO

General Provider Information

NPI Number	:	1306849302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROCKY LUPARDUS D.M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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1477758563 — ROCKY F. LUPARDUS, D.M.D., P.C.
Practice Location Address:

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