Healthcare Provider Details

I. General information

NPI: 1134805831
Provider Name (Legal Business Name): MARIA LAURA LOPEZ CASTRO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 S UNIVERSITY DR
FT LAUDERDALE FL
33328-2004
US

IV. Provider business mailing address

6120 REESE RD APT 412
DAVIE FL
33314-1260
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7500
  • Fax:
Mailing address:
  • Phone: 305-496-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: