MEDICARE: DR. JOSE LUIS LOPEZ BENDEZU DDS

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	102248	CA

General Provider Information

NPI Number	:	1033626247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS LOPEZ BENDEZU DDS

Provider Business Mailing Address
First Line	:	1007 MCCALL DR
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92881-8452
Country	:	US
Telephone Number	:	714-429-6734
Fax Number	:

Provider Business Practice Location Address
First Line	:	3127 BALDWIN PARK BLVD
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-4754
Country	:	US
Telephone Number	:	626-962-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2018
Last Update Date	:	09/16/2021

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