Provider Demographics
NPI:1417669672
Name:LOPEZ, CATHERINE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-5107
Mailing Address - Country:US
Mailing Address - Phone:262-527-6443
Mailing Address - Fax:
Practice Address - Street 1:1432 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-3228
Practice Address - Country:US
Practice Address - Phone:414-567-5380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6607-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist