Individual provider Active NPI

Hipolito D Lopez, D.D.S.

  • General Practice Dentistry
  • Rockford, IL
National Provider Identifier
1790795532
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Practice address
1301 N Alpine Rd
Rockford, IL 61107-2262
Phone
(815) 397-4280
Fax
(815) 484-2436
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X IL Primary

Addresses

Primary practice location

1301 N Alpine Rd
Rockford, IL 61107-2262

Mailing address

11086 Prairie Wind PL
Roscoe, IL 61073-6504
Phone (815) 623-6630

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170517003022 IL Order and Referring Only - DentistPractitioner - Dentist 8325369374

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
019-025007ILMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790795532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11086 PRAIRIE WIND PL",
            "city": "ROSCOE",
            "state": "IL",
            "postal_code": "610736504",
            "telephone_number": "815-623-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 N ALPINE RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611072262",
            "telephone_number": "815-397-4280",
            "fax_number": "815-484-2436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "HIPOLITO",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.