Provider Demographics
NPI:1922203835
Name:LOPEZ, MANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
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 1:1330 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-2033
Mailing Address - Country:US
Mailing Address - Phone:760-685-8130
Mailing Address - Fax:760-685-8130
Practice Address - Street 1:219 N HORNE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2808
Practice Address - Country:US
Practice Address - Phone:760-685-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47636122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist