Provider Demographics
NPI:1497424592
Name:JOSE LUIS LOPEZ DDS, INC.
Entity Type:Organization
Organization Name:JOSE LUIS LOPEZ DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:LOPEZ BENDEZU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-429-6734
Mailing Address - Street 1:3127 BALDWIN PARK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-4754
Mailing Address - Country:US
Mailing Address - Phone:626-962-3500
Mailing Address - Fax:626-962-3551
Practice Address - Street 1:3127 BALDWIN PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-4754
Practice Address - Country:US
Practice Address - Phone:626-962-3500
Practice Address - Fax:626-962-3551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1033626247OtherINSURERS
CA1033626247Medicaid