Provider Demographics
NPI:1023492238
Name:LOPEZ, JEIMMY NATALIA (DMD)
Entity type:Individual
Prefix:
First Name:JEIMMY
Middle Name:NATALIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E. NEWTON STREET
Mailing Address - Street 2:G-716
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-638-4636
Mailing Address - Fax:617-638-5322
Practice Address - Street 1:100 E. NEWTON STREET
Practice Address - Street 2:G-716
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-4636
Practice Address - Fax:617-638-5322
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist