Provider Demographics
NPI:1609257484
Name:LOLO, PATRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:LOLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4377
Mailing Address - Country:US
Mailing Address - Phone:786-624-3368
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4377
Practice Address - Country:US
Practice Address - Phone:786-624-3368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN213311223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223P0221XDental ProvidersDentistPediatric Dentistry