Provider Demographics
NPI:1760499222
Name:LIBUNAO, ALLAN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:J
Last Name:LIBUNAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:580 EAST BOUGHTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-972-1599
Mailing Address - Fax:630-972-1050
Practice Address - Street 1:580 E BOUGHTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-2140
Practice Address - Country:US
Practice Address - Phone:630-972-1599
Practice Address - Fax:630-972-1050
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology