MEDICARE: SANDRA LOPEZ D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22DI02870300	NJ

General Provider Information

NPI Number	:	1053998054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA LOPEZ D.M.D

Provider Business Mailing Address
First Line	:	180 W MARKET ST APT 724
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2789
Country	:	US
Telephone Number	:	860-819-5763
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 PASSAIC ST
Second Line	:
City	:	PASSAIC
State	:	NJ
Zip	:	07055-6460
Country	:	US
Telephone Number	:	201-210-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	12/28/2025

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