MEDICARE: DR. LUIS ALBERTO PERALTA DMD

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	122300000X	Dentist	019.031829	IL

General Provider Information

NPI Number	:	1619516556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS ALBERTO PERALTA DMD

Provider Business Mailing Address
First Line	:	1879 N MILWAUKEE AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5689
Country	:	US
Telephone Number	:	312-429-6506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1879 N MILWAUKEE AVE STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5689
Country	:	US
Telephone Number	:	312-429-6506
Fax Number	:

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

Provider Enumeration Date	:	12/23/2019
Last Update Date	:	05/01/2026

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