Individual
DR. ERNESTO ANTONIO VILLALOBOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
1318 MERIDEN ST, MENDOTA, IL 61342-1030
(815) 539-3000
Mailing address
672 ANITA LN, PRINCETON, IL 61356-2306
(815) 875-3032
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-026098
IL
1223G0001X
General Practice Dentistry
2901018233
MI
1223G0001X
General Practice Dentistry
DE00009492
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9177123
—
IL
Enumeration date
02/04/2007
Last updated
12/08/2013
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