Individual
EUSTORGIO A. LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Contact information
Practice address
3200 S UNIVERSITY DR, DAVIE, FL 33328-2018
(954) 262-7153
(954) 262-1793
Mailing address
3200 S UNIVERSITY DR, DAVIE, FL 33328-2018
(954) 262-7153
(954) 262-1793
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN 13112
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
ME74506
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015641700
—
FL
05
—
2686961-00
—
FL
Enumeration date
04/25/2006
Last updated
07/09/2023
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