Provider Demographics
NPI:1376207654
Name:LOPEZ LOPEZ, ARMANDO (DMD)
Entity Type:Individual
Prefix:
First Name:ARMANDO
Middle Name:
Last Name:LOPEZ LOPEZ
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 1:69 SALMAN ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-5710
Mailing Address - Country:US
Mailing Address - Phone:786-516-3882
Mailing Address - Fax:
Practice Address - Street 1:778 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-3016
Practice Address - Country:US
Practice Address - Phone:617-409-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26512122300000X
MADN18592401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist