Provider Demographics
NPI:1649315672
Name:LOPEZ, ROXANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
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 1:4501 W EXPRESSWAY 83 # 10
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-0029
Mailing Address - Country:US
Mailing Address - Phone:956-627-0525
Mailing Address - Fax:956-322-8982
Practice Address - Street 1:4501 W EXPRESSWAY 83 # 10
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-0029
Practice Address - Country:US
Practice Address - Phone:956-627-0525
Practice Address - Fax:956-627-0525
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649315672Medicaid