Provider Demographics
NPI:1720719883
Name:PUPO BARROSO, LORENA DENISE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORENA
Middle Name:DENISE
Last Name:PUPO BARROSO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 MIRAGE BAY CIR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-6630
Mailing Address - Country:US
Mailing Address - Phone:315-807-2767
Mailing Address - Fax:
Practice Address - Street 1:3448 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7108
Practice Address - Country:US
Practice Address - Phone:239-201-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27071122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist