Provider Demographics
NPI:1780847590
Name:LOPEZ, KATIE (DDS)
Entity type:Individual
Prefix:DR
First Name:KATIE
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 1:7686 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:703-672-2442
Mailing Address - Fax:202-688-3742
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:703-672-2442
Practice Address - Fax:202-688-3742
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist