Provider Demographics
NPI:1568521250
Name:LOPEZ, LESLIE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:H
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 1:129VILLA ST.
Mailing Address - Street 2:SUITE 23
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730
Mailing Address - Country:US
Mailing Address - Phone:787-848-6666
Mailing Address - Fax:787-848-6666
Practice Address - Street 1:129VILLA
Practice Address - Street 2:SUITE 23
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730
Practice Address - Country:US
Practice Address - Phone:787-848-6666
Practice Address - Fax:787-848-6666
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR03391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR40099OtherTRIPLE S