Provider Demographics
NPI:1831320282
Name:LOPEZ, DEBORA ISABEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:ISABEL
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 1:1255 W 46TH STREET
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3257
Mailing Address - Country:US
Mailing Address - Phone:305-558-2933
Mailing Address - Fax:305-558-6970
Practice Address - Street 1:1255 W 46TH STREET
Practice Address - Street 2:SUITE # 1
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-558-2933
Practice Address - Fax:305-558-6970
Is Sole Proprietor?:No
Enumeration Date:2009-08-03
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist