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Individual
MRS. LAURA DE LOPEZ
Active
Individual
MRS. LAURA DE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
47874
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47874
LICENSE #
CA
01
—
D47874
MEDI-CAL DENTAL PROGRAM
CA
Enumeration date
03/12/2007
Last updated
07/08/2007
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