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General NPI Number Information
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NPI Number | 1316186562
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Entity Type | Individual
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Provider Name | CARMEN DENISE MAROON-LOPEZ DDS
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Gender | Female
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 2648 MAIN ST STE A
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City | CHULA VISTA
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State | CA
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Zip | 91911-4664
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Country | US
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Telephone | 619-423-5200
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Fax | 619-423-2706
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Provider Business Mailing Address
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Address Line | 2648 MAIN ST STE A
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City | CHULA VISTA
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State | CA
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Zip | 91911-4664
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Country | US
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Telephone | 619-423-5200
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Fax | 619-423-2706
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D40672
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License Number State | CA
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