MEDICARE: ROSA C LOPEZ D.D.S

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	TX14950	TX

General Provider Information

NPI Number	:	1881715431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA C LOPEZ D.D.S

Provider Business Mailing Address
First Line	:	5510 ABRAMS RD STE 111
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2099
Country	:	US
Telephone Number	:	972-373-9903
Fax Number	:	972-373-9906

Provider Business Practice Location Address
First Line	:	5510 ABRAMS RD STE 111
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2099
Country	:	US
Telephone Number	:	972-373-9903
Fax Number	:	972-373-9906

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

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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