Provider Demographics
NPI:1174695084
Name:LOPEZ-REYES, JOSE A (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:LOPEZ-REYES
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 1:838 N CRESCENT LAKES CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9355
Mailing Address - Country:US
Mailing Address - Phone:316-440-9734
Mailing Address - Fax:
Practice Address - Street 1:3164 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-2204
Practice Address - Country:US
Practice Address - Phone:785-233-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100390900AMedicaid