Provider Demographics
NPI:1154167849
Name:JL LOPEZ BENDEZU DENTAL CORP
Entity type:Organization
Organization Name:JL LOPEZ BENDEZU DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:LOPEZ BENDEZU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-713-2041
Mailing Address - Street 1:2500 DEL ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4442
Mailing Address - Country:US
Mailing Address - Phone:909-713-2041
Mailing Address - Fax:909-713-2073
Practice Address - Street 1:2500 DEL ROSA AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4442
Practice Address - Country:US
Practice Address - Phone:909-713-2041
Practice Address - Fax:909-713-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-02
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty