Provider Demographics
NPI:1134125404
Name:LOPEZ, GILBERT H (DMD,MPH)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:H
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DMD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 CALLE WILSON
Mailing Address - Street 2:APT 701
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1717
Mailing Address - Country:US
Mailing Address - Phone:787-722-0108
Mailing Address - Fax:787-263-2311
Practice Address - Street 1:ANTONIO R. BARCELO CALLE NO.14
Practice Address - Street 2:SUITE 210
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-0000
Practice Address - Country:US
Practice Address - Phone:787-263-2311
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics