Provider Demographics
NPI:1629154166
Name:SAUZA LOPEZ, SAMUEL ISAIAS (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ISAIAS
Last Name:SAUZA LOPEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WEST 13TH AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025
Mailing Address - Country:US
Mailing Address - Phone:760-743-9003
Mailing Address - Fax:760-743-9007
Practice Address - Street 1:431 WEST 13TH AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-743-9003
Practice Address - Fax:760-743-9007
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9279201OtherDENTICAL