Provider Demographics
NPI:1861464257
Name:LOPEZ, WILLIAM JR (DMD, MS, MPA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:LOPEZ
Suffix:JR
Gender:M
Credentials:DMD, MS, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 12714
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9722
Mailing Address - Country:US
Mailing Address - Phone:412-725-8016
Mailing Address - Fax:
Practice Address - Street 1:2104 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228
Practice Address - Country:US
Practice Address - Phone:412-725-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist