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General NPI Number Information
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NPI Number | 1023783693
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Entity Type | Individual
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Provider Name | PEDRO SPERANDIO LOPES MORALES DMD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2021
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 18070 S TAMIAMI TRL STE 101
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City | FORT MYERS
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State | FL
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Zip | 33908-4602
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Country | US
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Telephone | 239-267-5000
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Fax | 239-984-8853
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Provider Business Mailing Address
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Address Line | 17 PINE LN BLDG 6
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City | SPRINGFIELD
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State | NJ
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Zip | 07081-4211
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Country | US
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Telephone | 862-704-9388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02861000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN26286
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License Number State | FL
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