Provider Demographics
NPI:1063606143
Name:LOPEZ, ANABELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANABELLE
Middle Name:
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 1:9299 SW 152ND ST
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1737
Mailing Address - Country:US
Mailing Address - Phone:305-546-0636
Mailing Address - Fax:305-278-1591
Practice Address - Street 1:9299 SW 152ND ST
Practice Address - Street 2:SUITE # 204
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1737
Practice Address - Country:US
Practice Address - Phone:305-546-0636
Practice Address - Fax:305-278-1591
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist