Healthcare Provider Details

I. General information

NPI: 1063606143
Provider Name (Legal Business Name): ANABELLE LOPEZ D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 SW 124TH AVE STE 106
MIAMI FL
33183-4631
US

IV. Provider business mailing address

8501 SW 124TH AVE STE 106
MIAMI FL
33183-4631
US

V. Phone/Fax

Practice location:
  • Phone: 305-603-8086
  • Fax: 305-639-8008
Mailing address:
  • Phone: 305-603-8086
  • Fax: 305-639-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: