Provider Demographics
NPI:1508951054
Name:LOPEZ, MARCUS ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:ANTHONY
Last Name: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 1:1235 SUMNER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118
Mailing Address - Country:US
Mailing Address - Phone:413-782-5159
Mailing Address - Fax:413-783-7094
Practice Address - Street 1:1235 SUMNER AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118
Practice Address - Country:US
Practice Address - Phone:413-782-5159
Practice Address - Fax:413-783-7094
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice