Provider Demographics
NPI:1407225394
Name:LOPEZ-BHUSHAN, DDS, P.C.
Entity Type:Organization
Organization Name:LOPEZ-BHUSHAN, DDS, P.C.
Other - Org Name:GLORIOUS SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LOPEZ-BHUSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-539-1995
Mailing Address - Street 1:500 FLOWER MOUND RD SPC 101
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3414
Mailing Address - Country:US
Mailing Address - Phone:972-539-1995
Mailing Address - Fax:972-539-1996
Practice Address - Street 1:500 FLOWER MOUND RD SPC 101
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3414
Practice Address - Country:US
Practice Address - Phone:972-539-1995
Practice Address - Fax:972-539-1996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty