Provider Demographics
NPI:1275033151
Name:KATYUSKA PAREDES LOPEZ DDS APC
Entity Type:Organization
Organization Name:KATYUSKA PAREDES LOPEZ DDS APC
Other - Org Name:KP DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-242-5585
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty