Provider Demographics
NPI:1689809196
Name:LOPEZ, LINDA A (RDH)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
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 1:1463 PIONEER RDG
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8163
Mailing Address - Country:US
Mailing Address - Phone:915-355-7666
Mailing Address - Fax:
Practice Address - Street 1:103 LIVINGSTON LOOP STE B3
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9762
Practice Address - Country:US
Practice Address - Phone:575-332-4047
Practice Address - Fax:575-332-4201
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH1388124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist