Provider Demographics
NPI:1306040597
Name:EDWARD LOPEZ AMERICA DENTAL
Entity Type:Organization
Organization Name:EDWARD LOPEZ AMERICA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NINOSKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-221-5931
Mailing Address - Street 1:2716 N BROADWAY STE 211
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2635
Mailing Address - Country:US
Mailing Address - Phone:323-221-5931
Mailing Address - Fax:323-221-6952
Practice Address - Street 1:2716 N BROADWAY STE 211
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2635
Practice Address - Country:US
Practice Address - Phone:323-221-5931
Practice Address - Fax:323-221-6952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty