Provider Demographics
NPI:1659439438
Name:LOPEZ, RAYMOND (DDS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
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 1:4601 DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-3358
Mailing Address - Country:US
Mailing Address - Phone:419-475-1956
Mailing Address - Fax:419-475-1979
Practice Address - Street 1:4601 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-3358
Practice Address - Country:US
Practice Address - Phone:419-475-1956
Practice Address - Fax:419-475-1979
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice