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General NPI Number Information
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NPI Number | 1861650277
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Entity Type | Organization
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Legal Business Name | JUAN R LOPEZ DDS
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 6941 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-5311
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Country | US
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Telephone | 580-536-9647
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Fax | 580-536-4075
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Provider Business Mailing Address
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Address Line | 6941 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-5311
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Country | US
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Telephone | 580-536-9647
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Fax | 580-536-4075
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Authorized Official
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Title or Position | BUSINESS COORDINATOR
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Name | KYLA D SHANNON
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Credential |
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Telephone | 580-536-9647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5022
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License Number State | OK
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