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General NPI Number Information
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NPI Number | 1548741572
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Entity Type | Individual
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Provider Name | ADRIANA LOPEZ DDS
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Gender | Female
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/03/2021
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Provider Practice Location Address
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Address Line | 2321 BETHARDS DR
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City | SANTA ROSA
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State | CA
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Zip | 95405-8536
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Country | US
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Telephone | 707-527-9280
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1064
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City | WINDSOR
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State | CA
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Zip | 95492-1064
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Country | US
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Telephone |
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 102845
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102845
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License Number State | CA
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