Healthcare Provider Details

I. General information

NPI: 1043834054
Provider Name (Legal Business Name): ANA LILIAN LOPEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8255 LEE VISTA BLVD STE D
ORLANDO FL
32829-8018
US

IV. Provider business mailing address

8255 LEE VISTA BLVD STE D
ORLANDO FL
32829-8018
US

V. Phone/Fax

Practice location:
  • Phone: 407-447-9060
  • Fax:
Mailing address:
  • Phone: 407-447-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN24866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: