Provider Demographics
NPI:1689764730
Name:LOPEZ, ARTURO J JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTURO
Middle Name:J
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5913 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7825
Mailing Address - Country:US
Mailing Address - Phone:423-362-7962
Mailing Address - Fax:423-362-7963
Practice Address - Street 1:5913 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7825
Practice Address - Country:US
Practice Address - Phone:423-362-7962
Practice Address - Fax:423-362-7963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX21272122300000X
TN9587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1777238OtherUNITED CONCORDIA
89D482OtherBLUE CROSS BLUE SHIELD