Provider Demographics
NPI:1306029855
Name:DILAN, LOURDES (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:
Last Name:DILAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 N WESTERN AVE
Mailing Address - Street 2:STE. 205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2589
Mailing Address - Country:US
Mailing Address - Phone:773-275-2300
Mailing Address - Fax:
Practice Address - Street 1:5214 N WESTERN AVE
Practice Address - Street 2:STE. 205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2589
Practice Address - Country:US
Practice Address - Phone:773-275-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice