Individual
SUSANA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
8291 SEMINOLE TRL, RUCKERSVILLE, VA 22968-3457
(434) 990-5722
Mailing address
8291 SEMINOLE TRL, RUCKERSVILLE, VA 22968-3457
(434) 990-5722
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
041417560
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2019
Last updated
04/07/2022
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