Provider Demographics
NPI:1972857746
Name:EDUARDO C. LOPEZ, D.D.S., PC
Entity Type:Organization
Organization Name:EDUARDO C. LOPEZ, D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-245-1915
Mailing Address - Street 1:9370 SW GREENBURG RD STE T
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5408
Mailing Address - Country:US
Mailing Address - Phone:503-245-1915
Mailing Address - Fax:
Practice Address - Street 1:9370 SW GREENBURG RD STE T
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5408
Practice Address - Country:US
Practice Address - Phone:503-245-1915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD92281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty