=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639142797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTIAN CLAUDIO LOPEZ DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2131 WESTCLIFF DR STE 210
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-5512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-722-1400
-----------------------------------------------------
Fax | 949-722-1620
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 LATTICE
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92603-4261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-737-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 50160
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------