MEDICARE: DR. MARIA LAURA LOPEZ CASTRO DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		FL

General Provider Information

NPI Number	:	1134805831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA LAURA LOPEZ CASTRO DDS

Provider Business Mailing Address
First Line	:	6120 REESE RD APT 412
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-1260
Country	:	US
Telephone Number	:	305-496-2017
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 S UNIVERSITY DR
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33328-2004
Country	:	US
Telephone Number	:	954-262-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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