Healthcare Provider Details

I. General information

NPI: 1659727089
Provider Name (Legal Business Name): WILMARIE LOPEZ-GARCIA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE EL JIBARO CARR #172 KM 13.5 BO, CIDRA, 00739
CIDRA PR
00739
US

IV. Provider business mailing address

4 VILLAS DEL BOSQUE
CIDRA PR
00739
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-8182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number3256
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3256
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number33668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: