Provider Demographics
NPI:1457768590
Name:KATIE LOPEZ DDS PLLC
Entity Type:Organization
Organization Name:KATIE LOPEZ DDS PLLC
Other - Org Name:ALEXANDRIA DENTAL SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:JOANY
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:571-224-2914
Mailing Address - Street 1:7686 RICHMOND HWY
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2844
Mailing Address - Country:US
Mailing Address - Phone:571-224-2914
Mailing Address - Fax:
Practice Address - Street 1:7686 RICHMOND HWY
Practice Address - Street 2:SUITE 201A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2844
Practice Address - Country:US
Practice Address - Phone:571-224-2914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014122051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty