Provider Demographics
NPI:1477968642
Name:LOPEZ, JOHANNA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:MARIA
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 1:1700 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3736
Mailing Address - Country:US
Mailing Address - Phone:828-693-5190
Mailing Address - Fax:
Practice Address - Street 1:1700 OLD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-2868
Practice Address - Country:US
Practice Address - Phone:828-693-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist