Provider Demographics
NPI:1942389465
Name:LOPEZ, CARLOS (DMD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 E RIGGS RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5411
Mailing Address - Country:US
Mailing Address - Phone:480-895-9373
Mailing Address - Fax:480-883-6708
Practice Address - Street 1:3960 E RIGGS RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5411
Practice Address - Country:US
Practice Address - Phone:480-895-9373
Practice Address - Fax:480-883-6708
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ207913OtherAHCCS