Provider Demographics
NPI:1871032946
Name:LOPEZ SILVA, MILMARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MILMARIE
Middle Name:
Last Name:LOPEZ SILVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1154
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1154
Mailing Address - Country:US
Mailing Address - Phone:787-454-2032
Mailing Address - Fax:
Practice Address - Street 1:1453 CALLE SAN IGNACIO
Practice Address - Street 2:URB. ALTAMESA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-792-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR33321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program