Provider Demographics
NPI:1225027634
Name:ANONUEVO, LOURDES TERRADO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:TERRADO
Last Name:ANONUEVO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3549 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3219
Mailing Address - Country:US
Mailing Address - Phone:773-509-9682
Mailing Address - Fax:773-509-9339
Practice Address - Street 1:3549 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3219
Practice Address - Country:US
Practice Address - Phone:773-509-9682
Practice Address - Fax:773-509-9339
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice