Healthcare Provider Details

I. General information

NPI: 1578553103
Provider Name (Legal Business Name): LUIS GUILLERMO LOPERA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 N MILWAUKEE AVE
WHEELING IL
60090-3013
US

IV. Provider business mailing address

383 LE PARC CIR
BUFFALO GROVE IL
60089-6909
US

V. Phone/Fax

Practice location:
  • Phone: 847-353-8050
  • Fax:
Mailing address:
  • Phone: 847-459-0188
  • Fax: 847-353-8051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: