Provider Demographics
NPI:1992949507
Name:LOPEZ-LLOREDA, JOSE FRANCISCO (DMD,PA)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FRANCISCO
Last Name:LOPEZ-LLOREDA
Suffix:
Gender:M
Credentials:DMD,PA
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD,PA
Mailing Address - Street 1:1938 WEST 60 STREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7598
Mailing Address - Country:US
Mailing Address - Phone:305-556-0155
Mailing Address - Fax:305-556-0156
Practice Address - Street 1:1938 W 60TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7598
Practice Address - Country:US
Practice Address - Phone:305-556-0155
Practice Address - Fax:305-556-0156
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8723OtherDENTIST LICENSE NO.