Provider Demographics
NPI:1326235805
Name:LOPEZ, ROSANA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSANA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:ROSANA
Other - Middle Name:
Other - Last Name:ALBERTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14715 BALGOWAN RD APT 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6475
Mailing Address - Country:US
Mailing Address - Phone:786-423-5953
Mailing Address - Fax:
Practice Address - Street 1:5810 S UNIVERSITY DR STE 128
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6109
Practice Address - Country:US
Practice Address - Phone:754-312-0855
Practice Address - Fax:954-302-6898
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN180771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice