Provider Demographics
NPI:1811925407
Name:POPPELL, MAGALY GONZALEZ (DMD)
Entity type:Individual
Prefix:DR
First Name:MAGALY
Middle Name:GONZALEZ
Last Name:POPPELL
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 1:1758 MARKHAM GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2797
Mailing Address - Country:US
Mailing Address - Phone:407-829-2047
Mailing Address - Fax:407-804-9902
Practice Address - Street 1:758 N SUN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2599
Practice Address - Country:US
Practice Address - Phone:407-804-9901
Practice Address - Fax:407-804-9902
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN116701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice