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General NPI Number Information
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NPI Number | 1316831167
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Entity Type | Individual
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Provider Name | LEANDRO RAMOS LOPEZ
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Gender | Male
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 4920 S 30TH ST
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City | OMAHA
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State | NE
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Zip | 68107-1590
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Country | US
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Telephone | 402-734-4110
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Fax |
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Provider Business Mailing Address
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Address Line | 202 E ELM ST
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City | RED OAK
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State | IA
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Zip | 51566-1504
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Country | US
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Telephone | 712-370-8933
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 3374
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License Number State | NE
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