Active NPI
Nicholas Lupo, DDS
- General Practice Dentistry
- Garland, TX
National Provider Identifier
1174121339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 36632
- Practice address
- 5129 N Garland Ave Ste 700
Garland, TX 75040-2746 - Phone
- (972) 276-5191
- NPI assigned
- Oct 11, 2020
- Last updated
- Oct 11, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 36632 | TX | Primary |
Addresses
Primary practice location
5129 N Garland Ave Ste 700
Garland, TX 75040-2746
Mailing address
1707 Park Cir
Garland, TX 75044-6853
Phone (701) 290-1904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36632 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Firewheel Modern Dentistry, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1602374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1602374400000",
"number": "1174121339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1707 PARK CIR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750446853",
"telephone_number": "701-290-1904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5129 N GARLAND AVE STE 700",
"city": "GARLAND",
"state": "TX",
"postal_code": "750402746",
"telephone_number": "972-276-5191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUPO",
"first_name": "NICHOLAS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-11",
"last_updated": "2020-10-11",
"certification_date": "2020-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "36632",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Garland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.