MEDICARE: DR. GILBERT H LOPEZ DMD.,MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	1844	PR

General Provider Information

NPI Number	:	1134125404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GILBERT H LOPEZ DMD.,MPH

Provider Business Mailing Address
First Line	:	1095 CALLE WILSON
Second Line	:	APT 701
City	:	SAN JUAN
State	:	PR
Zip	:	00907-1717
Country	:	US
Telephone Number	:	787-722-0108
Fax Number	:	787-263-2311

Provider Business Practice Location Address
First Line	:	ANTONIO R. BARCELO CALLE NO.14
Second Line	:	SUITE 210
City	:	CAYEY
State	:	PR
Zip	:	00736-0000
Country	:	US
Telephone Number	:	787-263-2311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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