Individual
MATTHEW LUPSAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6560 W FULLERTON AVE UNIT C106, STE T, CHICAGO, IL 60707
(773) 385-6700
Mailing address
16157 WHITE HAVEN DR, NORTHVILLE, MI 48168-2326
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.034201
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/10/2022
Last updated
05/24/2023
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