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General NPI Number Information
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NPI Number | 1558709485
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Entity Type | Organization
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Legal Business Name | FERMIN R. LOPEZ D.D.S. PA CORP
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 1125 NW 22ND AVE
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City | MIAMI
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State | FL
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Zip | 33125-2738
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Country | US
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Telephone | 305-649-6112
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Fax | 305-649-1803
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Provider Business Mailing Address
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Address Line | 1125 NW 22ND AVE
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City | MIAMI
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State | FL
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Zip | 33125-2738
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Country | US
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Telephone | 305-649-6112
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Fax | 305-649-1803
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Authorized Official
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Title or Position | OWNER
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Name | MR. MIRTA HECHAVARRIA
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Credential | D.D.S
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Telephone | 305-649-6112
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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 |
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License Number State |
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