Healthcare Provider Details

I. General information

NPI: 1558841890
Provider Name (Legal Business Name): CATHERINE ANNE LOPEZ GARCIA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 N PINE ISLAND RD
SUNRISE FL
33322-5203
US

IV. Provider business mailing address

16008 NW 87TH CT
MIAMI LAKES FL
33018-1427
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-9161
  • Fax: 954-473-9160
Mailing address:
  • Phone: 305-788-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number23637
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: