Provider Demographics
NPI:1629432240
Name:LOZANO, IRAIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRAIS
Middle Name:
Last Name:LOZANO
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 1:7056 HIGHLAND SPRING LANE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346
Mailing Address - Country:US
Mailing Address - Phone:619-600-2948
Mailing Address - Fax:
Practice Address - Street 1:510 BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5306
Practice Address - Country:US
Practice Address - Phone:619-476-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1016041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice