Provider Demographics
NPI:1184664054
Name:LOPEZ-LOPEZ, JOSE LUIS (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:LUIS
Last Name:LOPEZ-LOPEZ
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:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-897-8106
Mailing Address - Fax:
Practice Address - Street 1:AVE LOS PATRIOTAS KM 1.8
Practice Address - Street 2:ZIENA PROFESSIONAL PLAZA SUITE #7
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-8106
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
42437LOOtherTRIPLE S
042064OtherCRUZ AZUL
3107OtherINTERNATIONAL MED CARD
3513653OtherACAA
6690039OtherHUMANA
70163OtherPREFERRED MEDICARE CHOICE