Provider Demographics
NPI:1346341880
Name:LLOP, JOSE R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:LLOP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 CALLE MANUEL DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3506
Mailing Address - Country:US
Mailing Address - Phone:787-767-2014
Mailing Address - Fax:787-250-7982
Practice Address - Street 1:282 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3506
Practice Address - Country:US
Practice Address - Phone:787-767-2014
Practice Address - Fax:787-250-7982
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice