Provider Demographics
NPI:1649725268
Name:TAINA LOPEZ, CHRISTOPHER RALF (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RALF
Last Name:TAINA LOPEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:CRISTOPHER
Other - Middle Name:RALF
Other - Last Name:TAINA LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2107 ELLIS RD NW
Mailing Address - Street 2:APT #5
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-1134
Mailing Address - Country:US
Mailing Address - Phone:408-807-5712
Mailing Address - Fax:
Practice Address - Street 1:2315 EDGEWOOD RD SW
Practice Address - Street 2:#160
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3392
Practice Address - Country:US
Practice Address - Phone:319-423-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09346122300000X
VT016.0123604122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist