| Juan Guillermo Lopez Dmd Dds Pa | |
|
13300 S Cleveland Ave Ste 46 Fort Myers FL 33907-3883 | |
| (239) 768-1011 | |
| (239) 768-9311 |
| Full Name | Juan Guillermo Lopez Dmd Dds Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 13300 S Cleveland Ave Ste 46, Fort Myers, Florida |
| Authorized Official Name and Position | Juan Guillermo Lopez (OWNER) |
| Authorized Official Contact | 2397681011 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Juan Guillermo Lopez Dmd Dds Pa 13300 S Cleveland Ave Ste 46 Fort Myers FL 33907-3883 Ph: (239) 768-1011 | Juan Guillermo Lopez Dmd Dds Pa 13300 S Cleveland Ave Ste 46 Fort Myers FL 33907-3883 Ph: (239) 768-1011 |
| NPI Number | 1124745740 |
|---|---|
| Provider Enumeration Date | 10/24/2022 |
| Last Update Date | 10/24/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124745740 | NPI | - | NPPES |
| DN17696 | Other | FL | DENTAL LICENSE |
| 1447281720 | Other | FL | NPI 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Secondary |
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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