Provider Demographics
NPI:1447281720
Name:LOPEZ, JUAN G (DDS, DMD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:G
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DDS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4649
Mailing Address - Country:US
Mailing Address - Phone:954-227-4892
Mailing Address - Fax:954-227-4894
Practice Address - Street 1:5531 N UNIVERSITY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4649
Practice Address - Country:US
Practice Address - Phone:954-227-4892
Practice Address - Fax:954-227-4894
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2428843AMedicare ID - Type Unspecified