MEDICARE: JUAN JOSE LOPEZ DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1023820214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUAN JOSE LOPEZ DDS, INC.

Provider Business Mailing Address
First Line	:	115 PIRIE RD STE G
Second Line	:
City	:	OJAI
State	:	CA
Zip	:	93023-3100
Country	:	US
Telephone Number	:	805-646-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 PIRIE RD STE G
Second Line	:
City	:	OJAI
State	:	CA
Zip	:	93023-3100
Country	:	US
Telephone Number	:	805-646-1001
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JUAN JOSE LOPEZ
Credential	:	DDS
Telephone Number	:	805-646-1001

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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