Provider Demographics
NPI:1518211093
Name:LOPEZ, JACQUELINE V (DDS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:V
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8608 FOOTHILL BLVD.
Mailing Address - Street 2:118
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040
Mailing Address - Country:US
Mailing Address - Phone:818-422-2491
Mailing Address - Fax:
Practice Address - Street 1:8608 FOOTHILL BLVD
Practice Address - Street 2:118
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1963
Practice Address - Country:US
Practice Address - Phone:818-422-2491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice