Individual provider Active NPI

Bianca Mercedes Lopez-Isa, DDS

  • General Practice Dentistry
  • Brandon, FL
National Provider Identifier
1558914705
Registry record updated Jul 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN24432 Issued in FL
Practice address
225 Brandon Town Center Dr
Brandon, FL 33511-4728
Phone
(813) 438-8728
NPI assigned
Jul 17, 2019
Last updated
Jul 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN24432 FL Primary
Dentist 122300000X DN24432 FL

Addresses

Primary practice location

225 Brandon Town Center Dr
Brandon, FL 33511-4728

Mailing address

3711 W San Juan St
Tampa, FL 33629-6923

Other practice location 1

13018 US 301 S
Riverview, FL 33578-7420
Phone (813) 280-0121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201110000395 FL Order and Referring Only - DentistPractitioner - Dentist 6002226628

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN24432FLMDGeneral Practice Dentistry

Networks

  • Freedom Health HMO Network

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751587200000",
    "number": "1558914705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3711 W SAN JUAN ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336296923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BRANDON TOWN CENTER DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114728",
            "telephone_number": "813-438-8728"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13018 US 301 S",
            "address_purpose": "LOCATION",
            "city": "Riverview",
            "state": "FL",
            "postal_code": "335787420",
            "country_code": "US",
            "telephone_number": "813-280-0121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ-ISA",
        "first_name": "BIANCA",
        "middle_name": "MERCEDES",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-17",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN24432",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN24432",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, FL

Sources for this page

Verify at the official NPI Registry.