MEDICARE: DR. JUAN G LOPEZ DDS, DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7223	NC

General Provider Information

NPI Number	:	1447281720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN G LOPEZ DDS, DMD

Provider Business Mailing Address
First Line	:	5531 N UNIVERSITY DR
Second Line	:	SUITE 104
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4649
Country	:	US
Telephone Number	:	954-227-4892
Fax Number	:	954-227-4894

Provider Business Practice Location Address
First Line	:	5531 N UNIVERSITY DR
Second Line	:	SUITE 104
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-4649
Country	:	US
Telephone Number	:	954-227-4892
Fax Number	:	954-227-4894

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	11/30/2011

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