MEDICARE: ERICA MARIE LOPEZ RDH

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	124Q00000X	Dental Hygienist	032550	NY

General Provider Information

NPI Number	:	1932056736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA MARIE LOPEZ RDH

Provider Business Mailing Address
First Line	:	239 DARE RD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-1411
Country	:	US
Telephone Number	:	631-707-1689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1641 ROUTE 112 STE B
Second Line	:
City	:	MEDFORD
State	:	NY
Zip	:	11763-3663
Country	:	US
Telephone Number	:	631-758-3700
Fax Number	:

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

Provider Enumeration Date	:	03/12/2026
Last Update Date	:	03/12/2026

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