Healthcare Provider Details

I. General information

NPI: 1366639189
Provider Name (Legal Business Name): ELIZABETH M ORSINI-LOPEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ANTONIO VARCARCEL URB. REPARTO AMERICA
SAN JUAN PR
00923-3337
US

IV. Provider business mailing address

PO BOX 29736
SAN JUAN PR
00929-0736
US

V. Phone/Fax

Practice location:
  • Phone: 787-755-4347
  • Fax: 787-250-8450
Mailing address:
  • Phone: 787-755-4347
  • Fax: 787-283-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2700
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2700
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: