Provider Demographics
NPI:1639993728
Name:ROSELLE C LOPEZ LLC
Entity type:Organization
Organization Name:ROSELLE C LOPEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSELLE
Authorized Official - Middle Name:CABANA
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-510-3524
Mailing Address - Street 1:6521 AUTUMN GLEN CT.
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9228
Mailing Address - Country:US
Mailing Address - Phone:909-297-9026
Mailing Address - Fax:
Practice Address - Street 1:6521 AUTUMN GLEN CT.
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-9228
Practice Address - Country:US
Practice Address - Phone:909-297-9026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty