Provider Demographics
NPI:1184037277
Name:LOPEZ, TRACY LEE (DMD)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:LEE
Other - Last Name:VAN DUYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4038 THOMAS NELSON HWY
Mailing Address - Street 2:
Mailing Address - City:ARRINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22922-2302
Mailing Address - Country:US
Mailing Address - Phone:434-263-4000
Mailing Address - Fax:434-263-4160
Practice Address - Street 1:4038 THOMAS NELSON HWY
Practice Address - Street 2:
Practice Address - City:ARRINGTON
Practice Address - State:VA
Practice Address - Zip Code:22922-2302
Practice Address - Country:US
Practice Address - Phone:434-263-4000
Practice Address - Fax:434-263-4160
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20647122300000X
VA0401418185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist