Provider Demographics
NPI:1700144318
Name:LOPEZ, AMADEUS SEBASTIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMADEUS
Middle Name:SEBASTIAN
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11411 SOWARD DR
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1424
Mailing Address - Country:US
Mailing Address - Phone:631-682-8559
Mailing Address - Fax:
Practice Address - Street 1:7521 VIRGINIA OAKS DR STE 230
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3831
Practice Address - Country:US
Practice Address - Phone:703-754-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15376122300000X
NY056808122300000X
VA0401414689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist