Provider Demographics
NPI:1275265662
Name:LOPEZ, MELISSA MARIA (DMD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MONTCLAIR RD APT 5305
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2039
Mailing Address - Country:US
Mailing Address - Phone:205-566-1323
Mailing Address - Fax:
Practice Address - Street 1:1705 MAIN AVE SW STE A
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-7207
Practice Address - Country:US
Practice Address - Phone:256-856-9901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0007074-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist