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General NPI Number Information
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NPI Number | 1043704786
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Entity Type | Individual
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Provider Name | DR. ALBERTO LOPEZ DE CASTRO BOLUFER
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Gender | Male
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Dates
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Enumeration Date | 06/16/2018
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 21202 OLEAN BLVD FL 33952
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6751
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Country | US
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Telephone | 941-629-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 3438 N SALFORD BLVD
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City | NORTH PORT
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State | FL
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Zip | 34286-7439
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Country | US
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Telephone | 786-718-5655
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN23495
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License Number State | FL
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