Provider Demographics
NPI:1336227743
Name:LOPEZ, GIANIRA (DDS)
Entity type:Individual
Prefix:DR
First Name:GIANIRA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:GIANIRA
Other - Middle Name:
Other - Last Name:MALDANADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6601 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3747
Mailing Address - Country:US
Mailing Address - Phone:480-456-0821
Mailing Address - Fax:480-756-6536
Practice Address - Street 1:5270 W BASELINE RD
Practice Address - Street 2:#130
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6959
Practice Address - Country:US
Practice Address - Phone:602-237-8182
Practice Address - Fax:480-756-6536
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018076122300000X
AZD7464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4382600Medicaid
MID802165OtherBCBS