Healthcare Provider Details

I. General information

NPI: 1669110144
Provider Name (Legal Business Name): LESLIE JANET LOPEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 SOUTHERN BLVD SE
RIO RANCHO NM
87124-3741
US

IV. Provider business mailing address

401 BAYVIEW AVE
NAPERVILLE IL
60565-2112
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-8600
  • Fax:
Mailing address:
  • Phone: 505-306-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDB-2026-0108
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: