Provider Demographics
NPI:1609271550
Name:LOPEZ PEREZ, VICTOR M (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:M
Last Name:LOPEZ PEREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7158 SW 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-2808
Mailing Address - Country:US
Mailing Address - Phone:305-271-2517
Mailing Address - Fax:305-271-2140
Practice Address - Street 1:7158 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:305-271-2517
Practice Address - Fax:305-271-2140
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL209921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice