Healthcare Provider Details

I. General information

NPI: 1770411555
Provider Name (Legal Business Name): CARLOS DAVID LOPEZ MONTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

3 CALLER ST
PEABODY MA
01960-5613
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-9832
  • Fax:
Mailing address:
  • Phone: 781-513-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL101482
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: