Jade Rashida Lopez, DDS
Individual provider Active NPI Dentist · Lake Wales, FL
NPI 1649901976 · NPPES record last updated May 17, 2023
Key facts
- NPI
- 1649901976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN27169 (FL)
- Practice address
- 24185 US Highway 27
Lake Wales, FL 33859-7819 - Phone
- (863) 676-6200
- NPI assigned
- Jun 17, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN27169 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bangash Dentistry PLLC | Current |
Accepting new patients | |
| Maryam Bangash DDS Holdings PLLC | Past |
Accepting new patients |
Locations
24185 US Highway 27
Lake Wales, FL 33859
Phone (863) 455-7444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | DN27169 | FL | Yes |
Addresses
Primary practice location
24185 US Highway 27
Lake Wales, FL 33859-7819
Mailing address
3610 SW 165TH Ave
Miramar, FL 33027-4513
Phone (954) 662-4922
Other practice location 1
7814 N Dale Mabry Hwy
Tampa, FL 33614-3220
Phone (813) 397-5300
Other providers in Lake Wales, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.