Healthcare Provider Details

I. General information

NPI: 1699107987
Provider Name (Legal Business Name): DEVIN JORDAN LOPEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 TERRA NOVA BLVD
PACIFICA CA
94044
US

IV. Provider business mailing address

1031 TERRA NOVA BLVD
PACIFICA CA
94044
US

V. Phone/Fax

Practice location:
  • Phone: 650-359-1463
  • Fax: 650-359-4489
Mailing address:
  • Phone: 650-359-1463
  • Fax: 650-359-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number63939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: