Provider Demographics
NPI:1174681787
Name:LOZANO, ROBERT IBARRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IBARRA
Last Name:LOZANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16959 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2553
Mailing Address - Country:US
Mailing Address - Phone:858-485-0707
Mailing Address - Fax:858-485-9068
Practice Address - Street 1:16959 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2553
Practice Address - Country:US
Practice Address - Phone:858-485-0707
Practice Address - Fax:858-485-9068
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice