Provider Demographics
NPI:1992147326
Name:GARCIA LOPEZ, DORGIS (DMD)
Entity type:Individual
Prefix:DR
First Name:DORGIS
Middle Name:
Last Name:GARCIA LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18652 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2406
Mailing Address - Country:US
Mailing Address - Phone:305-474-0400
Mailing Address - Fax:
Practice Address - Street 1:18652 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2406
Practice Address - Country:US
Practice Address - Phone:305-474-0400
Practice Address - Fax:306-474-0400
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN202581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice