MEDICARE: JOHANNA LOPEZ

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	11280	SC

General Provider Information

NPI Number	:	1932079910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA LOPEZ

Provider Business Mailing Address
First Line	:	102 WAHOO CIR
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-9817
Country	:	US
Telephone Number	:	786-538-5248
Fax Number	:

Provider Business Practice Location Address
First Line	:	7510 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-5801
Country	:	US
Telephone Number	:	786-538-5248
Fax Number	:

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

Provider Enumeration Date	:	11/06/2025
Last Update Date	:	03/12/2026

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Directions to “ JOHANNA LOPEZ ” Practice Location

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