Basic Information
| Provider Information | |||||||||
| NPI: | 1699816108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOPEZ-SHAMS | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | CAROLINA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOPEZ-SHAMS | ||||||||
| OtherFirstName: | CAROL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.D.S. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3452 MAJESTIC DR | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957654857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164359511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6015 WATT AVE | ||||||||
| Address2: | SUITE #2 | ||||||||
| City: | NORTH HIGHLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956604294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793925 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 04/14/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 37579 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.