Healthcare Provider Details

I. General information

NPI: 1962421495
Provider Name (Legal Business Name): HECTOR LOPEZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 CORPUS CHRISTI ST STE. B
LAREDO TX
78040-5313
US

IV. Provider business mailing address

1219 CORPUS CHRISTI ST STE. B
LAREDO TX
78040-5313
US

V. Phone/Fax

Practice location:
  • Phone: 956-727-3593
  • Fax: 956-791-3743
Mailing address:
  • Phone: 956-727-3593
  • Fax: 956-791-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: