Healthcare Provider Details

I. General information

NPI: 1316100464
Provider Name (Legal Business Name): TERESA E LOZANO MD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 BRICKELL BAY DR APT 1103
MIAMI FL
33131-2998
US

IV. Provider business mailing address

1155 BRICKELL BAY DR APT 1103
MIAMI FL
33131-2998
US

V. Phone/Fax

Practice location:
  • Phone: 305-804-9074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberME88197
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN17503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: