Provider Demographics
NPI:1134275787
Name:EMMA V. LOPEZ, D.D.S., P.A.
Entity type:Organization
Organization Name:EMMA V. LOPEZ, D.D.S., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-742-0355
Mailing Address - Street 1:5206 IRVINGTON BLVD
Mailing Address - Street 2:STE. A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1932
Mailing Address - Country:US
Mailing Address - Phone:713-742-0355
Mailing Address - Fax:713-742-0357
Practice Address - Street 1:5206 IRVINGTON BLVD
Practice Address - Street 2:STE. 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009451801Medicaid