| Ernesto A Villalobos, Dds, Ms, Llc | |
|
1318 Meriden St Mendota IL 61342-1030 | |
| (815) 539-3000 | |
| Not Available |
| Full Name | Ernesto A Villalobos, Dds, Ms, Llc |
|---|---|
| Speciality | Dentist |
| Location | 1318 Meriden St, Mendota, Illinois |
| Authorized Official Name and Position | Ernesto A Villalobos (PRESIDENT) |
| Authorized Official Contact | 8158753032 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ernesto A Villalobos, Dds, Ms, Llc 672 Anita Ln Princeton IL 61356-2306 Ph: (815) 875-3032 | Ernesto A Villalobos, Dds, Ms, Llc 1318 Meriden St Mendota IL 61342-1030 Ph: (815) 539-3000 |
| NPI Number | 1528400371 |
|---|---|
| Provider Enumeration Date | 07/22/2013 |
| Last Update Date | 12/08/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528400371 | NPI | - | NPPES |
| 9177123 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 019026098 (Illinois) | Primary |
| 122300000X | Dentist | 2901018233 (Michigan) | Secondary |
West Side Family Dentistry, Ltd Dental Clinic Medicare: Medicare Enrolled Practice Location: 709 Plaza Dr, Mendota, IL 61342 Phone: 815-539-7004 Fax: 815-539-7060 | |
Krenz Dental Corp. Ltd Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 704 Indiana Ave, Mendota, IL 61342 Phone: 815-538-5316 Fax: 815-539-7626 |