Provider Demographics
NPI:1487650164
Name:LOPEZ RIVERA, TEODORO (DMD, MSCD)
Entity Type:Individual
Prefix:DR
First Name:TEODORO
Middle Name:
Last Name:LOPEZ RIVERA
Suffix:
Gender:M
Credentials:DMD, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330707
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-0707
Mailing Address - Country:US
Mailing Address - Phone:787-844-1880
Mailing Address - Fax:787-844-5885
Practice Address - Street 1:EDIFICIO CLAUSELLS 129 CALLE VILLA
Practice Address - Street 2:SUITE 24
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-844-1880
Practice Address - Fax:787-844-5885
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR040471OtherCRUZ AZUL
PR237025OtherUTI
PR4722OtherINTERNATIONAL MEDICAL CAR
PR40719OtherSEGUROS SERVICIOS SALUD
PR7310173OtherHUMANA