Active NPI
Juan Pedro Lopez, DMD
- Dentist
- Newington, CT
National Provider Identifier
1861471682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 008786
- Practice address
- 555 Willard Ave
VA Dental Clinic
Newington, CT 06111-2631 - Phone
- (860) 667-6781
- Fax
- (860) 667-6827
- NPI assigned
- Jan 11, 2006
- 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 | 008786 | CT | Primary |
Addresses
Primary practice location
555 Willard Ave
VA Dental Clinic
Newington, CT 06111-2631
Mailing address
555 Willard Ave
VA Dental Clinic
Newington, CT 06111-2631
Phone (860) 667-6781
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008786 | Other | CT | DENTIST LICENSE |
| 30033 | Other | CT | CONTROLLED SUBSTANCE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243123200000",
"number": "1861471682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 WILLARD AVE",
"address_2": "VA DENTAL CLINIC",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "061112631",
"telephone_number": "860-667-6781",
"fax_number": "860-667-6827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 WILLARD AVE",
"address_2": "VA DENTAL CLINIC",
"city": "NEWINGTON",
"state": "CT",
"postal_code": "061112631",
"telephone_number": "860-667-6781",
"fax_number": "860-667-6827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "JUAN",
"middle_name": "PEDRO",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-11",
"last_updated": "2009-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "008786",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTIST LICENSE",
"identifier": "008786",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONTROLLED SUBSTANCE",
"identifier": "30033",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.