Provider Demographics
NPI:1316146343
Name:MARRERO-LOPEZ, LILLIAM E (DMD)
Entity type:Individual
Prefix:DR
First Name:LILLIAM
Middle Name:E
Last Name:MARRERO-LOPEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W 6TH ST STE 114
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3066
Mailing Address - Country:US
Mailing Address - Phone:951-442-5605
Mailing Address - Fax:
Practice Address - Street 1:1450 W 6TH ST STE 114
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3066
Practice Address - Country:US
Practice Address - Phone:951-371-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist