MEDICARE: ERIC LOPEZ DDS, INC.

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	122300000X	Dentist	21799	OH

General Provider Information

NPI Number	:	1245694132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC LOPEZ DDS, INC.

Provider Business Mailing Address
First Line	:	7540 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3233
Country	:	US
Telephone Number	:	513-821-3118
Fax Number	:	513-821-5219

Provider Business Practice Location Address
First Line	:	7540 READING RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3233
Country	:	US
Telephone Number	:	513-821-3118
Fax Number	:	513-821-5219

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIC MANUEL LOPEZ
Credential	:	D.D.S.
Telephone Number	:	513-257-8948

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	04/07/2016

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