Provider Demographics
NPI:1023783693
Name:SPERANDIO LOPES MORALES, PEDRO (DMD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:SPERANDIO LOPES MORALES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:17 PINE LN BLDG 6
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-4211
Mailing Address - Country:US
Mailing Address - Phone:862-704-9388
Mailing Address - Fax:
Practice Address - Street 1:18070 S TAMIAMI TRL STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4602
Practice Address - Country:US
Practice Address - Phone:239-267-5000
Practice Address - Fax:239-984-8853
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02861000122300000X
FLDN26286122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist