Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 0401414156 | VA |
Y | 1223P0221X | Pediatric Dentist | 14406 | MD |
N | 1223P0221X | Pediatric Dentist | DS036367 | PA |
NPI | 1053362590 |
---|---|
Provider Name | Dr. Joseph Wong Lopez |
First Address | Alexandria, VA 22314-4555 |
Second Address | Alexandria, VA 22314-4555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 17/08/2021 |