Provider Demographics
NPI:1427496140
Name:LOPEZ-ALDAZABAL, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:LOPEZ-ALDAZABAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 COTTMAN AVE
Mailing Address - Street 2:YES DENTAL P.C.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1008
Mailing Address - Country:US
Mailing Address - Phone:215-332-8700
Mailing Address - Fax:
Practice Address - Street 1:2327 COTTMAN AVE
Practice Address - Street 2:YES DENTAL P.C.
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1008
Practice Address - Country:US
Practice Address - Phone:215-332-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS039848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program