Healthcare Provider Details

I. General information

NPI: 1932622917
Provider Name (Legal Business Name): MATTHEW LOPEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 10TH ST E
PALMETTO FL
34221-4013
US

IV. Provider business mailing address

8845 MOONLIT MEADOWS LOOP
RIVERVIEW FL
33578-8836
US

V. Phone/Fax

Practice location:
  • Phone: 941-315-9914
  • Fax:
Mailing address:
  • Phone: 407-414-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN22842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: