Individual
DR. INEZ MARIE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
903 C NORTH 5TH STREET, ESTANCIA, NM 87016-0807
(505) 384-2777
(505) 384-2204
Mailing address
PO BOX 807, 903 C NORTH 5TH STREET, ESTANCIA, NM 87016-0807
(505) 384-2777
(505) 384-2204
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2624
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1766494
UNITED CONCORDIA
NM
05
—
66726557
—
NM
01
—
850206810
TRICARE
NM
01
—
9179209
DORAL DENTAL
NM
01
—
DD2624
DELTA DENTAL
NM
Enumeration date
08/17/2006
Last updated
06/17/2008
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