Provider Demographics
NPI:1396830592
Name:LOPEZ, MIGUEL ANGEL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:MIGUEL
Other - Middle Name:A
Other - Last Name:LOPEZ
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:3131 N BOULEVARD STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-5527
Mailing Address - Country:US
Mailing Address - Phone:813-229-7427
Mailing Address - Fax:813-669-5478
Practice Address - Street 1:3131 N BOULEVARD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-5527
Practice Address - Country:US
Practice Address - Phone:813-229-7427
Practice Address - Fax:813-669-5478
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN131141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice