Provider Demographics
NPI:1801183918
Name:LOPEZ, MAYRA MARIA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:MARIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6791 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2923
Mailing Address - Country:US
Mailing Address - Phone:305-261-0633
Mailing Address - Fax:305-261-2437
Practice Address - Street 1:6791 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2923
Practice Address - Country:US
Practice Address - Phone:305-261-0633
Practice Address - Fax:305-261-2437
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDDS 20991122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist