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General NPI Number Information
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NPI Number | 1932056736
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Entity Type | Individual
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Provider Name | ERICA MARIE LOPEZ RDH
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Gender | Female
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Dates
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Enumeration Date | 03/12/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 1641 ROUTE 112 STE B
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City | MEDFORD
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State | NY
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Zip | 11763-3663
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Country | US
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Telephone | 631-758-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 239 DARE RD
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City | SELDEN
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State | NY
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Zip | 11784-1411
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Country | US
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Telephone | 631-707-1689
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 032550
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License Number State | NY
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