Healthcare Provider Details

I. General information

NPI: 1003135047
Provider Name (Legal Business Name): ERNEST S OPIOLA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 09/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W SAINT CHARLES RD
VILLA PARK IL
60181-2426
US

IV. Provider business mailing address

128 W SAINT CHARLES RD
VILLA PARK IL
60181-2426
US

V. Phone/Fax

Practice location:
  • Phone: 630-686-2434
  • Fax: 630-686-2436
Mailing address:
  • Phone: 630-686-2434
  • Fax: 630-686-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019028296
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: