Individual
JOSE ALEJANDRO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, ORTHO CERT.
Contact information
Practice address
903 JORDAN BLASS DR STE 102, MELBOURNE, FL 32940-1325
(321) 425-5050
Mailing address
2568 45TH ST APT 2, ASTORIA, NY 11103-1123
(347) 985-5185
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
0401418725
VA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN27847
FL
Other
Enumeration date
01/30/2024
Last updated
01/30/2024
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