=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770407256
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALBERTO LOPEZ DESCHAMPS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2026
-----------------------------------------------------
Last Update Date | 08/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 VILLAGE GRN STE 150
-----------------------------------------------------
City | LINCOLNSHIRE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60069-3079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-501-4724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2154 S 11TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53215-2708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-501-4724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019.037321
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------