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General NPI Number Information
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NPI Number | 1396475505
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Entity Type | Individual
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Provider Name | DIEGO ALFONSO LOPEZ DMD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 11831 CULEBRA RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4578
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Country | US
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Telephone | 210-625-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 8142 CACTUS BEND DR
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City | SAN ANTONIO
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State | TX
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Zip | 78254-4537
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Country | US
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Telephone | 210-630-7160
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38653
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License Number State | TX
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