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General NPI Number Information
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NPI Number | 1467405423
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Entity Type | Individual
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Provider Name | MILLIED LOPEZ DE VICTORIA D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 18255 HOMESTEAD AVE
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City | MIAMI
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State | FL
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Zip | 33157-5564
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Country | US
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Telephone | 305-278-6420
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Fax | 786-573-2867
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Provider Business Mailing Address
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Address Line | 10300 SW 216TH ST
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City | CUTLER BAY
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State | FL
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Zip | 33190-1003
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Country | US
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Telephone | 305-253-5100
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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 | DN17815
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7692
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License Number State | NC
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