Provider Demographics
NPI:1134348006
Name:LOZADA, IGOR ALEXIS
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:ALEXIS
Last Name:LOZADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 BEACON ST
Mailing Address - Street 2:APT # 1503
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-5350
Mailing Address - Country:US
Mailing Address - Phone:617-877-1093
Mailing Address - Fax:
Practice Address - Street 1:1297 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5242
Practice Address - Country:US
Practice Address - Phone:617-566-1524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics