MEDICARE: DR. GISELA M LOPEZ 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	122300000X	Dentist	DI15631	NJ

General Provider Information

NPI Number	:	1841483039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GISELA M LOPEZ DMD

Provider Business Mailing Address
First Line	:	625 BRIARWOOD COURT
Second Line	:
City	:	ORADELL
State	:	NJ
Zip	:	07649
Country	:	US
Telephone Number	:	201-265-4660
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 MIDLAND AVE
Second Line	:
City	:	GARFIELD
State	:	NJ
Zip	:	07026-1658
Country	:	US
Telephone Number	:	973-340-1182
Fax Number	:

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	05/21/2021

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