Provider Demographics
NPI:1518572114
Name:LOPEZ, ERICK DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:DANIEL
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 1:2801 SOFFIANO LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-1410
Mailing Address - Country:US
Mailing Address - Phone:956-774-9975
Mailing Address - Fax:
Practice Address - Street 1:1355 E LEAGUE CITY PKWY STE 500
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7096
Practice Address - Country:US
Practice Address - Phone:956-774-9975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice