Provider Demographics
NPI:1952678765
Name:LOPEZ PEREZ, RICARDO ALEJANDRO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ALEJANDRO
Last Name:LOPEZ PEREZ
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:X6 CALLE 25
Mailing Address - Street 2:VISTA AZUL
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-2618
Mailing Address - Country:US
Mailing Address - Phone:787-647-4347
Mailing Address - Fax:
Practice Address - Street 1:111 AVE LOS PATRIOTAS KM 33.2 ZIEMA PROFESSIONAL PLAZA
Practice Address - Street 2:SUITE #7
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-897-8106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist