Provider Demographics
NPI:1245343748
Name:LOPEZ, INEZ MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:INEZ
Middle Name:MARIE
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:PO BOX 807
Mailing Address - Street 2:903 C NORTH 5TH STREET
Mailing Address - City:ESTANCIA
Mailing Address - State:NM
Mailing Address - Zip Code:87016-0807
Mailing Address - Country:US
Mailing Address - Phone:505-384-2777
Mailing Address - Fax:505-384-2204
Practice Address - Street 1:903 C NORTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:ESTANCIA
Practice Address - State:NM
Practice Address - Zip Code:87016-0807
Practice Address - Country:US
Practice Address - Phone:505-384-2777
Practice Address - Fax:505-384-2204
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2624122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850206810OtherTRICARE
NM66726557Medicaid
NMDD2624OtherDELTA DENTAL
NM1766494OtherUNITED CONCORDIA
NM9179209OtherDORAL DENTAL