Provider Demographics
NPI:1831303429
Name:DR. JUAN G. LOPEZ DMD DDS PA
Entity Type:Organization
Organization Name:DR. JUAN G. LOPEZ DMD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALCERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-523-7301
Mailing Address - Street 1:1711 MONTFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1711 MONTFORD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3721
Practice Address - Country:US
Practice Address - Phone:704-523-7301
Practice Address - Fax:704-525-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7223261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery