MEDICARE: DR. JAMES IRVINE LOPEZ DDS, MS, MS

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	1223P0221X	Pediatric Dentistry	9074	GA
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	9074	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	40278	OTHER	GA	AVESIS

General Provider Information

NPI Number	:	1912115056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES IRVINE LOPEZ DDS, MS, MS

Provider Business Mailing Address
First Line	:	1834 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8029
Country	:	US
Telephone Number	:	706-324-1834
Fax Number	:	706-324-5101

Provider Business Practice Location Address
First Line	:	1834 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8029
Country	:	US
Telephone Number	:	706-324-1834
Fax Number	:	706-324-5101

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	09/11/2025

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