Provider Demographics
NPI:1619033156
Name:LOPEZ RAMOS, GRISEL DE LOS A (DMD)
Entity Type:Individual
Prefix:DR
First Name:GRISEL
Middle Name:DE LOS A
Last Name:LOPEZ RAMOS
Suffix:
Gender:F
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:URB LOS ANGELES
Mailing Address - Street 2:C F8
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:SANTIAGO VIDARTE #21
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-1520
Practice Address - Fax:787-893-6071
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice