Provider Demographics
NPI:1992917934
Name:LOPEZ-GALAN, MARIA ROSA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ROSA
Last Name:LOPEZ-GALAN
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 1:2660 SW 110TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2382
Mailing Address - Country:US
Mailing Address - Phone:305-223-0018
Mailing Address - Fax:
Practice Address - Street 1:4689 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2133
Practice Address - Country:US
Practice Address - Phone:305-665-1655
Practice Address - Fax:305-665-3827
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00131131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice