Ernesto Antonio Villalobos, DDS, MS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-026098 Issued in IL

Practice address

1318 Meriden St
Mendota, IL 61342-1030

Phone

(815) 539-3000

NPI assigned

Feb 4, 2007

Last updated

Dec 8, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ernesto a Villalobos, DDS, Ms, LLC

  • Dentist
  • Mendota, IL
  • NPI 1528400371
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386460800000",
    "number": "1356489801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "672 ANITA LN",
            "city": "PRINCETON",
            "state": "IL",
            "postal_code": "613562306",
            "telephone_number": "815-875-3032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1318 MERIDEN ST",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613421030",
            "telephone_number": "815-539-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLALOBOS",
        "first_name": "ERNESTO",
        "middle_name": "ANTONIO",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-04",
        "last_updated": "2013-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-026098",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00009492",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018233",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9177123",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara N Van de Wyngaerde OD PC
• Jennifer Tomkiewicz
• Yessenia Torres, DC
• Tara Nicole Vandewyngaerde, O.D
• Michael P Vercimak, MD
• Selena Waido
• Marissa Jasmine Weber
• West Side Family Dentistry, LTD
• Jared M Wise, PT
• Carissa Wooddell, MS CCC-SLP

• General Practice Dentistry in Mendota, IL
• Providers in Mendota, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.