Individual
DR. JUAN PEDRO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
555 WILLARD AVE, VA DENTAL CLINIC, NEWINGTON, CT 06111-2631
(860) 667-6781
(860) 667-6827
Mailing address
555 WILLARD AVE, VA DENTAL CLINIC, NEWINGTON, CT 06111-2631
(860) 667-6781
(860) 667-6827
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
008786
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008786
DENTIST LICENSE
CT
01
—
30033
CONTROLLED SUBSTANCE
CT
Enumeration date
01/11/2006
Last updated
05/24/2009
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