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General NPI Number Information
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NPI Number | 1831211432
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Entity Type | Individual
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Provider Name | MICHAEL LOPEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 3639 S ORLANDO DR
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City | SANFORD
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State | FL
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Zip | 32773-5611
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Country | US
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Telephone | 407-347-4814
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Fax |
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Provider Business Mailing Address
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Address Line | 389 TWELVE OAKS DR.
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City | WINTER SPRINGS
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State | FL
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Zip | 32708
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Country | US
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Telephone | 321-287-0776
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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 | DN16564
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License Number State | FL
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