Provider Demographics
NPI:1578125688
Name:LOPEZ-PORTILLO, ABEL DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABEL
Middle Name:DAVID
Last Name:LOPEZ-PORTILLO
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 1:1119 CROSSWIND DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4109
Mailing Address - Country:US
Mailing Address - Phone:469-682-7110
Mailing Address - Fax:
Practice Address - Street 1:3550 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5633
Practice Address - Country:US
Practice Address - Phone:682-400-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX351501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice