Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019028296 | IL |
Y | 213EG0000X | General Practice | 019028296 | IL |
NPI | 1003135047 |
---|---|
Provider Name | Dr. Ernest S Opiola |
First Address | Villa Park, IL 60181-2426 |
Second Address | Villa Park, IL 60181-2426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2010 |
Last Update Date | 20/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1396126546 | DENTALMAX, P.C. (01) | IL |