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General NPI Number Information
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NPI Number | 1245343748
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Entity Type | Individual
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Provider Name | INEZ MARIE LOPEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 903 C NORTH 5TH STREET
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City | ESTANCIA
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State | NM
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Zip | 87016-0807
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Country | US
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Telephone | 505-384-2777
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Fax | 505-384-2204
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Provider Business Mailing Address
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Address Line | PO BOX 807 903 C NORTH 5TH STREET
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City | ESTANCIA
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State | NM
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Zip | 87016-0807
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Country | US
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Telephone | 505-384-2777
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Fax | 505-384-2204
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD2624
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License Number State | NM
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