Individual
IVAN LOPEZ SABARRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4080 LAFAYETTE CENTER DR STE 160-B, CHANTILLY, VA 20151-1247
(703) 230-1000
Mailing address
11405 DELSIGNORE DR, FAIRFAX, VA 22030-5549
(703) 598-0132
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401416667
VA
Other
Enumeration date
08/14/2019
Last updated
08/14/2019
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