Provider Demographics
NPI:1194964221
Name:JAY R. LOPEZ, DDS, PC
Entity type:Organization
Organization Name:JAY R. LOPEZ, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-886-8090
Mailing Address - Street 1:6375 E. TANQUE VERDE RD
Mailing Address - Street 2:STE 30
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-1696
Mailing Address - Country:US
Mailing Address - Phone:520-886-8090
Mailing Address - Fax:520-886-8274
Practice Address - Street 1:6375 E. TANQUE VERDE RD
Practice Address - Street 2:STE 30
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-1696
Practice Address - Country:US
Practice Address - Phone:520-886-8090
Practice Address - Fax:520-886-8274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty