Active NPI
Antonio Lopez-Ibarra, D.D.S
- Dentist
- Kennewick, WA
National Provider Identifier
1043626674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60487049
- Practice address
- 3711 Plaza Way Ste 120
Kennewick, WA 99338-2718 - Phone
- (509) 579-0759
- Fax
- (844) 416-0355
- NPI assigned
- Jul 2, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60487049 | WA | Primary |
Addresses
Primary practice location
3711 Plaza Way Ste 120
Kennewick, WA 99338-2718
Mailing address
509 Jordan LN
Richland, WA 99352-8537
Phone (509) 833-7663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60487049 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri City Dental Care, PLLC | Dentist | Past | Accepting new patients |
Networks
- WA PPO C-SNP
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Kennewick, WA
- NPI 1396194338
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1043626674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "509 JORDAN LN",
"city": "RICHLAND",
"state": "WA",
"postal_code": "993528537",
"telephone_number": "509-833-7663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3711 PLAZA WAY STE 120",
"city": "KENNEWICK",
"state": "WA",
"postal_code": "993382718",
"telephone_number": "509-579-0759",
"fax_number": "844-416-0355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ-IBARRA",
"first_name": "ANTONIO",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60487049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennewick, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.