Provider Demographics
NPI:1245365295
Name:LOPEZ, CARLOS A (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:A
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:215 CALLE TOUS SOTO
Mailing Address - Street 2:URB BALDRICH
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4312
Mailing Address - Country:US
Mailing Address - Phone:787-444-7910
Mailing Address - Fax:
Practice Address - Street 1:215 CALLE TOUS SOTO
Practice Address - Street 2:URB. BALDRICH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4312
Practice Address - Country:US
Practice Address - Phone:787-444-7910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18951223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRN689OtherDENTIST
PR7290033OtherDENTIST
PR041451OtherDENTIST
PR206104OtherDENTIST
PR41707OtherDENTIST