Provider Demographics
NPI:1275945727
Name:LOPEZ, DANIEL ALONSO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALONSO
Last Name: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 1:1612 N LEE TREVINO DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5176
Mailing Address - Country:US
Mailing Address - Phone:915-593-6661
Mailing Address - Fax:
Practice Address - Street 1:1612 N LEE TREVINO DR
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5176
Practice Address - Country:US
Practice Address - Phone:915-593-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist