Provider Demographics
NPI:1043626674
Name:LOPEZ-IBARRA, ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:LOPEZ-IBARRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 JORDAN LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8537
Mailing Address - Country:US
Mailing Address - Phone:509-833-7663
Mailing Address - Fax:
Practice Address - Street 1:3711 PLAZA WAY STE 120
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2718
Practice Address - Country:US
Practice Address - Phone:509-579-0759
Practice Address - Fax:844-416-0355
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60487049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist