=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023820214
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN JOSE LOPEZ DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 PIRIE RD STE G
-----------------------------------------------------
City | OJAI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93023-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-646-1001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 PIRIE RD STE G
-----------------------------------------------------
City | OJAI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93023-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-646-1001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JUAN JOSE LOPEZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 805-646-1001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------