Provider Demographics
NPI:1578553103
Name:LOPERA, LUIS GUILLERMO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GUILLERMO
Last Name:LOPERA
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 1:383 LE PARC CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6909
Mailing Address - Country:US
Mailing Address - Phone:847-459-0188
Mailing Address - Fax:847-353-8051
Practice Address - Street 1:143 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-3013
Practice Address - Country:US
Practice Address - Phone:847-353-8050
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice