Provider Demographics
NPI:1447308614
Name:LOPEZ, JOSE M (DMD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:LOPEZ
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 1:1717 BROWN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4730
Mailing Address - Country:US
Mailing Address - Phone:915-544-1600
Mailing Address - Fax:915-544-1610
Practice Address - Street 1:1717 BROWN ST STE 1B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4730
Practice Address - Country:US
Practice Address - Phone:915-544-1600
Practice Address - Fax:915-544-1610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice