Healthcare Provider Details

I. General information

NPI: 1801075775
Provider Name (Legal Business Name): ROXANA LOPEZ, DDS,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4406 SIERRA DR
PALMHURST TX
78573-0409
US

IV. Provider business mailing address

2512 N. CONWAY DRIVE
MISSION TX
78572-0409
US

V. Phone/Fax

Practice location:
  • Phone: 956-566-8233
  • Fax:
Mailing address:
  • Phone: 956-483-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22473
License Number StateTX

VIII. Authorized Official

Name: DR. ROXANA LOPEZ
Title or Position: DENTIST
Credential: DDS
Phone: 956-566-8233