Provider Demographics
NPI:1558709485
Name:FERMIN R. LOPEZ D.D.S. PA CORP
Entity Type:Organization
Organization Name:FERMIN R. LOPEZ D.D.S. PA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECHAVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-649-6112
Mailing Address - Street 1:1125 NW 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2738
Mailing Address - Country:US
Mailing Address - Phone:305-649-6112
Mailing Address - Fax:305-649-1803
Practice Address - Street 1:1125 NW 22ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-2738
Practice Address - Country:US
Practice Address - Phone:305-649-6112
Practice Address - Fax:305-649-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty