Provider Demographics
NPI:1760494678
Name:TERESA E LOZANO MD DDS PA
Entity Type:Organization
Organization Name:TERESA E LOZANO MD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:LOZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:305-379-6037
Mailing Address - Street 1:1155 BRICKELL BAY DR APT 1103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2998
Mailing Address - Country:US
Mailing Address - Phone:305-379-6037
Mailing Address - Fax:
Practice Address - Street 1:1155 BRICKELL BAY DR APT 1103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2998
Practice Address - Country:US
Practice Address - Phone:305-379-6037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88197204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty