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General NPI Number Information
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NPI Number | 1679977862
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Entity Type | Organization
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Legal Business Name | LOPEZ-BHUSHAN, DDS
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Dates
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Enumeration Date | 10/16/2014
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 500 FLOWER MOUND RD STE. 101
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3412
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Country | US
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Telephone | 972-539-1995
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Fax |
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Provider Business Mailing Address
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Address Line | 500 FLOWER MOUND RD STE. 101
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3412
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Country | US
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Telephone | 972-539-1995
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. GLORIA E LOPEZ-BHUSHAN
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Credential | D.D.S.
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Telephone | 972-539-1995
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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 | 21167
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License Number State | TX
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