Provider Demographics
NPI:1639176035
Name:LOPEZ, JESUS RICARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:RICARDO
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:R
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6375 E TANQUE VERDE RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3852
Mailing Address - Country:US
Mailing Address - Phone:520-886-8090
Mailing Address - Fax:520-886-8274
Practice Address - Street 1:6375 E TANQUE VERDE RD
Practice Address - Street 2:SUITE 30
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3852
Practice Address - Country:US
Practice Address - Phone:520-886-8090
Practice Address - Fax:520-886-8274
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD49031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice