Provider Demographics
NPI:1932327483
Name:LOS, JOHN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:LOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 E OGDEN AVE
Mailing Address - Street 2:SUITE 132
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3633
Mailing Address - Country:US
Mailing Address - Phone:630-323-9540
Mailing Address - Fax:630-323-9545
Practice Address - Street 1:201 E OGDEN AVE
Practice Address - Street 2:SUITE 132
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3633
Practice Address - Country:US
Practice Address - Phone:630-323-9540
Practice Address - Fax:630-323-9545
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-182451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice