Provider Demographics
NPI:1982907374
Name:CARLOS LOPEZ LLC
Entity Type:Organization
Organization Name:CARLOS LOPEZ LLC
Other - Org Name:RIGGS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-540-3799
Mailing Address - Street 1:3960 E RIGGS RD
Mailing Address - Street 2:STE. 5
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5411
Mailing Address - Country:US
Mailing Address - Phone:480-895-9373
Mailing Address - Fax:480-883-6708
Practice Address - Street 1:3960 E RIGGS RD
Practice Address - Street 2:STE. 5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5411
Practice Address - Country:US
Practice Address - Phone:480-895-9373
Practice Address - Fax:480-883-6708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty