Healthcare Provider Details

I. General information

NPI: 1396660189
Provider Name (Legal Business Name): MARIA JOSE LOPEZ MENDEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N BANK ST
LURAY VA
22835-1115
US

IV. Provider business mailing address

10861 GAMBRIL DR APT 33
MANASSAS VA
20109-6593
US

V. Phone/Fax

Practice location:
  • Phone: 540-743-3434
  • Fax:
Mailing address:
  • Phone: 904-504-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419998
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: