MEDICARE: DR. ERNEST S OPIOLA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019028296	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1396126546	OTHER	IL	DENTALMAX, P.C.

General Provider Information

NPI Number	:	1003135047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST S OPIOLA DDS

Provider Business Mailing Address
First Line	:	128 W SAINT CHARLES RD
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2426
Country	:	US
Telephone Number	:	630-686-2434
Fax Number	:	630-686-2436

Provider Business Practice Location Address
First Line	:	128 W SAINT CHARLES RD
Second Line	:
City	:	VILLA PARK
State	:	IL
Zip	:	60181-2426
Country	:	US
Telephone Number	:	630-686-2434
Fax Number	:	630-686-2436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2010
Last Update Date	:	09/20/2015

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