Provider Demographics
NPI:1275926065
Name:KARINA VERA-LOPEZ DDS PLLC
Entity Type:Organization
Organization Name:KARINA VERA-LOPEZ DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA-LOPEZ DDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-626-9487
Mailing Address - Street 1:4391 RIDGEWOOD CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5399
Mailing Address - Country:US
Mailing Address - Phone:703-590-4666
Mailing Address - Fax:703-897-1526
Practice Address - Street 1:4391 RIDGEWOOD CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5399
Practice Address - Country:US
Practice Address - Phone:703-590-4666
Practice Address - Fax:703-897-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014132161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty