Provider Demographics
NPI:1225415862
Name:MAROON-LOPEZ DDS, PC
Entity Type:Organization
Organization Name:MAROON-LOPEZ DDS, PC
Other - Org Name:CARMEN DENISE MAROON LOPEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MAROON-LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:619-423-5200
Mailing Address - Street 1:2648 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4664
Mailing Address - Country:US
Mailing Address - Phone:619-423-5200
Mailing Address - Fax:619-423-2706
Practice Address - Street 1:2648 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-4664
Practice Address - Country:US
Practice Address - Phone:619-423-5200
Practice Address - Fax:619-423-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316186562OtherDENTAL