Provider Demographics
NPI:1194916452
Name:LOPEZ, ROSELLE CABANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ROSELLE
Middle Name:CABANA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROSELLE
Other - Middle Name:CABANA
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7725 GATEWAY UNIT 3328
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-5849
Mailing Address - Country:US
Mailing Address - Phone:909-510-3524
Mailing Address - Fax:
Practice Address - Street 1:7725 GATEWAY UNIT 3328
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-5849
Practice Address - Country:US
Practice Address - Phone:909-510-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist