Provider Demographics
NPI:1013086784
Name:LOPEZ, GRACIELA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:L
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:PO BOX 17179
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-7179
Mailing Address - Country:US
Mailing Address - Phone:949-567-3176
Mailing Address - Fax:949-567-3185
Practice Address - Street 1:301 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3910
Practice Address - Country:US
Practice Address - Phone:619-476-1444
Practice Address - Fax:619-476-0656
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA442091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice