Individual
DIANA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2111 E OAKLAND AVE STE D, BLOOMINGTON, IL 61701-5783
(309) 663-6564
Mailing address
2111 E OAKLAND AVE STE D, BLOOMINGTON, IL 61701-5783
(309) 663-6564
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
019036011
IL
1223P0700X
Prosthodontics
Primary
021003464
IL
Other
Enumeration date
04/05/2022
Last updated
08/14/2025
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