Carlos Lopez Diaz DDS Dental Corporation

Primary specialty

DentistTaxonomy code 122300000X

License

101712 Issued in CA

Legal business name

CARLOS LOPEZ DIAZ DDS DENTAL CORPORATION

Practice address

19046 La Puente Rd
West Covina, CA 91792

Phone

(626) 200-1900

NPI assigned

May 23, 2018

Organization subpart

Yes

Parent organization

CARLOS LOPEZ DIAZ DDS DENTAL COAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carlos Lopez Diaz, DDS

Title

President

Phone

(226) 200-1900

Specialties & licenses 1

Addresses

Other names 1

• SMY Life Dental Doing business as

Part of

Carlos Lopez Diaz DDS Dental Corporation

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527033600000",
    "number": "1225529464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19046 LA PUENTE RD",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91792",
            "telephone_number": "626-200-1900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19046 LA PUENTE RD",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91792",
            "telephone_number": "626-200-1900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLOS LOPEZ DIAZ DDS DENTAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARLOS LOPEZ DIAZ DDS DENTAL CO",
        "enumeration_date": "2018-05-23",
        "last_updated": "2018-05-23",
        "status": "A",
        "authorized_official_last_name": "LOPEZ DIAZ",
        "authorized_official_first_name": "CARLOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "226-200-1900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "101712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMY Life Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in West Covina, CA
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.