Organization
ERNESTO A VILLALOBOS, DDS, MS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNESTO A VILLALOBOS DDS, MS (PRESIDENT)
(815) 875-3032
Entity
Organization
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
122300000X
Dentist
Primary
019026098
IL
122300000X
Dentist
2901018233
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9177123
—
IL
Enumeration date
07/22/2013
Last updated
12/08/2013
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