Provider Demographics
NPI:1871909184
Name:LOPEZ, MARIA GARCIA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GARCIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CAYUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4323
Mailing Address - Country:US
Mailing Address - Phone:814-944-0607
Mailing Address - Fax:814-944-0587
Practice Address - Street 1:305 CAYUGA AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4323
Practice Address - Country:US
Practice Address - Phone:814-944-0607
Practice Address - Fax:814-944-0587
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist