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General NPI Number Information
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NPI Number | 1528493640
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Entity Type | Individual
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Provider Name | STEPHANIE LOPEZ D.M.D., M.S.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 7875 SW 104TH ST STE 104
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City | KENDALL
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State | FL
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Zip | 33156-2642
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Country | US
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Telephone | 305-271-9202
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Fax |
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Provider Business Mailing Address
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Address Line | 3610 SOLANA RD
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City | COCONUT GROVE
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State | FL
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Zip | 33133-6143
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Country | US
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Telephone | 305-498-3637
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN20394
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License Number State | FL
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