MEDICARE: EMMA V. LOPEZ, D.D.S., P.A.

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	18695	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134275787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMA V. LOPEZ, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	5206 IRVINGTON BLVD
Second Line	:	STE. A
City	:	HOUSTON
State	:	TX
Zip	:	77009-1932
Country	:	US
Telephone Number	:	713-742-0355
Fax Number	:	713-742-0357

Provider Business Practice Location Address
First Line	:	5206 IRVINGTON BLVD
Second Line	:	STE. A
City	:	HOUSTON
State	:	TX
Zip	:	77009-1932
Country	:	US
Telephone Number	:	713-742-0355
Fax Number	:	713-742-0357

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. EMMA VIRGINIA LOPEZ
Credential	:	D.D.S.
Telephone Number	:	713-742-0355

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	03/16/2012

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