Provider Demographics
NPI:1982486254
Name:LOPEZ VEGA, PEDRO ARTURO (RDH)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ARTURO
Last Name:LOPEZ VEGA
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 THOMAS LAKE POINTE RD APT 315
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2536
Mailing Address - Country:US
Mailing Address - Phone:952-649-9972
Mailing Address - Fax:
Practice Address - Street 1:1510 THOMAS LAKE POINTE RD APT 315
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2536
Practice Address - Country:US
Practice Address - Phone:952-649-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH11639124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist