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General NPI Number Information
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NPI Number | 1417033382
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Entity Type | Organization
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Legal Business Name | LOPEZ FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1123 W WISCONSIN ST
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City | SPARTA
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State | WI
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Zip | 54656-2233
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Country | US
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Telephone | 608-269-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 W WISCONSIN ST
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City | SPARTA
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State | WI
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Zip | 54656-2233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. STEVEN LOPEZ
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Credential | DDS
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Telephone | 608-269-8400
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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 | 4770-15
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License Number State | WI
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