Provider Demographics
NPI:1053362590
Name:LOPEZ, JOSEPH WONG (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WONG
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 DUKE ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4555
Mailing Address - Country:US
Mailing Address - Phone:571-257-5744
Mailing Address - Fax:571-535-3533
Practice Address - Street 1:3223 DUKE ST STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4555
Practice Address - Country:US
Practice Address - Phone:571-257-5744
Practice Address - Fax:571-535-3533
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0363671223P0221X
VA04014141561223P0221X
MD144061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry