Provider Demographics
NPI:1194736462
Name:LOPEZ DRISCOLL, LUZ MIRIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:MIRIAM
Last Name:LOPEZ DRISCOLL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:LUZ
Other - Middle Name:MIRIAM
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:818 18TH ST NW
Mailing Address - Street 2:#530
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006
Mailing Address - Country:US
Mailing Address - Phone:202-223-6053
Mailing Address - Fax:202-955-6032
Practice Address - Street 1:818 18TH ST NW
Practice Address - Street 2:#530
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-223-6053
Practice Address - Fax:202-955-6032
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5135122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist