# JUAN R LOPEZ DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861650277
- **Authorized official:** KYLA D SHANNON (BUSINESS COORDINATOR)
- **Authorized official phone:** (580) 536-9647

## Contact information

- **Practice address:** 6941 W GORE BLVD, LAWTON, OK 73505-5311
- **Practice address phone:** (580) 536-9647
- **Practice address fax:** (580) 536-4075
- **Mailing address:** 6941 W GORE BLVD, LAWTON, OK 73505-5311
- **Mailing address phone:** (580) 536-9647
- **Mailing address fax:** (580) 536-4075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 5022 | OK | Yes |

## Other

- **Enumeration date:** 06/02/2008
- **Last updated:** 06/02/2008