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NPI Code Detail

MEDICARE: MILLIED LOPEZ DE VICTORIA D.M.D.

MEDICARE: MILLIED LOPEZ DE VICTORIA D.M.D.
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
11223G0001XGeneral Practice DentistryDN17815FL
21223G0001XGeneral Practice Dentistry7692NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467405423
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILLIED LOPEZ DE VICTORIA D.M.D.
Provider Business Mailing Address
First Line : 10300 SW 216TH ST
Second Line :
City : CUTLER BAY
State : FL
Zip : 33190-1003
Country : US
Telephone Number : 305-253-5100
Fax Number :
Provider Business Practice Location Address
First Line : 18255 HOMESTEAD AVE
Second Line :
City : MIAMI
State : FL
Zip : 33157-5564
Country : US
Telephone Number : 305-278-6420
Fax Number : 786-573-2867
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 12/19/2016

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