Provider Demographics
NPI:1215089842
Name:LOPEZ-CALERO, JOSE A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:LOPEZ-CALERO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1893
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1893
Mailing Address - Country:US
Mailing Address - Phone:787-769-6684
Mailing Address - Fax:787-769-9103
Practice Address - Street 1:5725 BLVD MEDIA LUNA, SUITE 5
Practice Address - Street 2:GALERIAS DE ESCORIAL SHOPPING CENTER
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-769-6684
Practice Address - Fax:787-769-9103
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2751122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist