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General NPI Number Information
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NPI Number | 1639993728
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Entity Type | Organization
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Legal Business Name | ROSELLE C LOPEZ LLC
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 6521 AUTUMN GLEN CT.
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-9228
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Country | US
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Telephone | 909-297-9026
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Fax |
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Provider Business Mailing Address
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Address Line | 6521 AUTUMN GLEN CT.
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91701-9228
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Country | US
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Telephone | 909-297-9026
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | ROSELLE CABANA LOPEZ
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Credential | DDS
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Telephone | 909-510-3524
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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