Provider Demographics
NPI:1841483039
Name:LOPEZ, GISELA M (DMD)
Entity type:Individual
Prefix:DR
First Name:GISELA
Middle Name:M
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 1:625 BRIARWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649
Mailing Address - Country:US
Mailing Address - Phone:201-265-4660
Mailing Address - Fax:
Practice Address - Street 1:535 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-1658
Practice Address - Country:US
Practice Address - Phone:973-340-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist