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NPI Code Detail

MEDICARE: JOSE L. LOPEZ, DDS, INC

MEDICARE: JOSE L. 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
11223G0001XGeneral Practice Dentistry44013CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B44013OTHERCADENTICAL PROVIDER NUMBER

General Provider Information

NPI Number : 1700915808
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOSE L. LOPEZ, DDS, INC
Provider Business Mailing Address
First Line : 3490 PALM AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-1664
Country : US
Telephone Number : 619-423-1351
Fax Number :
Provider Business Practice Location Address
First Line : 3490 PALM AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-1664
Country : US
Telephone Number : 619-423-1351
Fax Number :
Authorized Official
Title or Position : PRESIDENT OF CORPORATION
Name : DR. JOSE L. LOPEZ
Credential : DDS
Telephone Number : 619-423-1351
Provider Enumeration Date : 03/05/2007
Last Update Date : 08/22/2020

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