Provider Demographics
NPI:1164456117
Name:VALDE LOPEZ, JULIE ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:JULIE ANN
Middle Name:
Last Name:VALDE LOPEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 CAMINO DOS RIOS
Mailing Address - Street 2:SUITE #401
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1134
Mailing Address - Country:US
Mailing Address - Phone:805-499-7676
Mailing Address - Fax:805-375-8642
Practice Address - Street 1:2814 CAMINO DOS RIOS
Practice Address - Street 2:SUITE #401
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1134
Practice Address - Country:US
Practice Address - Phone:805-499-7676
Practice Address - Fax:805-375-8642
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice