Provider Demographics
NPI:1023060597
Name:LOPEZ, EMMA VIRGINIA (DDS)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:VIRGINIA
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 1:3101 SCHWEIKHARDT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-5153
Mailing Address - Country:US
Mailing Address - Phone:713-742-0355
Mailing Address - Fax:
Practice Address - Street 1:5206 IRVINGTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-1932
Practice Address - Country:US
Practice Address - Phone:713-742-0355
Practice Address - Fax:713-742-0357
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009451801Medicaid