MEDICARE: JOSEPHINA SILVA LOPES DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11141	NC

General Provider Information

NPI Number	:	1063999167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPHINA SILVA LOPES DMD

Provider Business Mailing Address
First Line	:	511 ROSENGARTEN ALY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-2153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6480 TRYON RD STE A
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-7050
Country	:	US
Telephone Number	:	919-277-7840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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