Provider Demographics
NPI:1902313927
Name:LEAL LOPEZ, ONELVIS (DDS)
Entity type:Individual
Prefix:DR
First Name:ONELVIS
Middle Name:
Last Name:LEAL LOPEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7886 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-1708
Mailing Address - Country:US
Mailing Address - Phone:727-545-3800
Mailing Address - Fax:
Practice Address - Street 1:7886 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-1708
Practice Address - Country:US
Practice Address - Phone:727-545-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist