Provider Demographics
NPI:1275749889
Name:LOZANO, JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LOZANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 S STAPLES ST STE B
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:361-853-9209
Practice Address - Street 1:2802 S STAPLES ST STE B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3617
Practice Address - Country:US
Practice Address - Phone:361-853-9220
Practice Address - Fax:361-853-9209
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16855122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist