Provider Demographics
NPI:1134500937
Name:LOPEZ, BRENDA (DDS)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E GARRISON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5153
Mailing Address - Country:US
Mailing Address - Phone:704-866-8281
Mailing Address - Fax:
Practice Address - Street 1:1601 E GARRISON BLVD STE D
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5153
Practice Address - Country:US
Practice Address - Phone:704-866-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100201223P0300X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist