Provider Demographics
NPI:1790795532
Name:LOPEZ, HIPOLITO D (DDS)
Entity Type:Individual
Prefix:DR
First Name:HIPOLITO
Middle Name:D
Last Name:LOPEZ
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 1:11086 PRAIRIE WIND PL
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-6504
Mailing Address - Country:US
Mailing Address - Phone:815-623-6630
Mailing Address - Fax:
Practice Address - Street 1:1301 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-2262
Practice Address - Country:US
Practice Address - Phone:815-397-4280
Practice Address - Fax:815-484-2436
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice