Provider Demographics
NPI:1083758296
Name:LOPEZ, KATYUSKA PAREDES (DDS)
Entity Type:Individual
Prefix:PROF
First Name:KATYUSKA
Middle Name:PAREDES
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23318 OLIVE WOOD PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5219
Mailing Address - Country:US
Mailing Address - Phone:951-242-5585
Mailing Address - Fax:951-242-5587
Practice Address - Street 1:23318 OLIVE WOOD PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5219
Practice Address - Country:US
Practice Address - Phone:951-242-5585
Practice Address - Fax:951-242-5587
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA509671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD50967OtherDENTI-CAL