Provider Demographics
NPI:1407124290
Name:LAKEWOOD CERRITOS DENTAL CTRS
Entity Type:Organization
Organization Name:LAKEWOOD CERRITOS DENTAL CTRS
Other - Org Name:ABELARDO LOPEZ DDS A DENTAL CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOSMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-804-2296
Mailing Address - Street 1:5819 ADENMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713
Mailing Address - Country:US
Mailing Address - Phone:562-804-2296
Mailing Address - Fax:562-804-1686
Practice Address - Street 1:5819 ADENMOOR AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713
Practice Address - Country:US
Practice Address - Phone:562-804-2296
Practice Address - Fax:562-804-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA187451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty