Provider Demographics
NPI:1912115056
Name:LOPEZ, JAMES IRVINE (DDS, MS, MS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:IRVINE
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DDS, MS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8029
Mailing Address - Country:US
Mailing Address - Phone:706-324-1834
Mailing Address - Fax:706-324-5101
Practice Address - Street 1:1834 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8029
Practice Address - Country:US
Practice Address - Phone:706-324-1834
Practice Address - Fax:706-324-5101
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90741223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00184984AMedicaid
GA40278OtherAVESIS