Healthcare Provider Details

I. General information

NPI: 1215089842
Provider Name (Legal Business Name): JOSE A. LOPEZ-CALERO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 BLVD MEDIA LUNA, SUITE 5 GALERIAS DE ESCORIAL SHOPPING CENTER
CAROLINA PR
00987
US

IV. Provider business mailing address

PO BOX 1893
CAROLINA PR
00984-1893
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-6684
  • Fax: 787-769-9103
Mailing address:
  • Phone: 787-769-6684
  • Fax: 787-769-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2751
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2751
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: