Provider Demographics
NPI:1417173113
Name:LOPEZ, STEVEN R (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
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 1:610 WYNDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2442
Mailing Address - Country:US
Mailing Address - Phone:210-828-5160
Mailing Address - Fax:
Practice Address - Street 1:1919 OAKWELL FARMS PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-1777
Practice Address - Country:US
Practice Address - Phone:210-656-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist