Provider Demographics
NPI:1467070201
Name:RIVERA LOPEZ, SHERLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERLEY
Middle Name:
Last Name:RIVERA LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7239
Mailing Address - Country:US
Mailing Address - Phone:407-701-0659
Mailing Address - Fax:
Practice Address - Street 1:14606 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8413
Practice Address - Country:US
Practice Address - Phone:941-216-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL250911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice