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General NPI Number Information
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NPI Number | 1659189850
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Entity Type | Organization
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Legal Business Name | SUSANA LOPEZ DDS PLLC
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 3223 DUKE ST STE H
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4555
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Country | US
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Telephone | 703-646-0362
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Fax |
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Provider Business Mailing Address
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Address Line | 6607 CAVALIER DR
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City | ALEXANDRIA
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State | VA
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Zip | 22307-1308
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Country | US
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Telephone | 571-314-4655
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | SUSANA LOPEZ
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Credential | DDS
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Telephone | 571-314-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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