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General NPI Number Information
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NPI Number | 1902068018
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Entity Type | Organization
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Legal Business Name | GILBERTO LOPEZ DDS INC
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1021 S 21ST ST
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City | FORT SMITH
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State | AR
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Zip | 72901-4007
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Country | US
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Telephone | 479-434-4277
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Fax | 479-434-4279
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Provider Business Mailing Address
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Address Line | 1021 S 21ST ST
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City | FORT SMITH
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State | AR
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Zip | 72901-4007
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Country | US
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Telephone | 479-434-4277
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Fax | 479-434-4279
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Authorized Official
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Title or Position | DDS
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Name | GILBERTO LOPEZ
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Credential |
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Telephone | 479-434-4277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3501
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License Number State | AR
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