Provider Demographics
NPI:1447616651
Name:HEALTHY 32 DENTAL PLLC
Entity Type:Organization
Organization Name:HEALTHY 32 DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-593-6661
Mailing Address - Street 1:1612 N LEE TREVINO DR STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5177
Mailing Address - Country:US
Mailing Address - Phone:915-593-6661
Mailing Address - Fax:915-595-8924
Practice Address - Street 1:1612 N LEE TREVINO DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5177
Practice Address - Country:US
Practice Address - Phone:915-593-6661
Practice Address - Fax:915-595-8924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty