Provider Demographics
NPI:1053717322
Name:AMY HERTZ, DMD AND MINTA LOPEZ-TORRES, DMD
Entity type:Organization
Organization Name:AMY HERTZ, DMD AND MINTA LOPEZ-TORRES, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-328-9492
Mailing Address - Street 1:5030 SR 46 STE 1018
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9247
Mailing Address - Country:US
Mailing Address - Phone:407-328-9492
Mailing Address - Fax:
Practice Address - Street 1:5030 WEST SR 46, SUITE 1018
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:407-328-9492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16360122300000X
FLDN16478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty