Provider Demographics
NPI:1952591869
Name:LOPEZ, PATRICIA Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:Y
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 1:675 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3518
Mailing Address - Country:US
Mailing Address - Phone:626-938-0195
Mailing Address - Fax:626-938-0193
Practice Address - Street 1:675 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3518
Practice Address - Country:US
Practice Address - Phone:626-938-0195
Practice Address - Fax:626-938-0193
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55961122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist