Active NPI
Diana Lopez
- Prosthodontics
- Bloomington, IL
National Provider Identifier
1821739749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 021003464
- Practice address
- 2111 E Oakland Ave Ste D
Bloomington, IL 61701-5783 - Phone
- (309) 663-6564
- NPI assigned
- Apr 5, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019036011 | IL | |
| Prosthodontics | 1223P0700X | 021003464 | IL | Primary |
Addresses
Primary practice location
2111 E Oakland Ave Ste D
Bloomington, IL 61701-5783
Mailing address
2111 E Oakland Ave Ste D
Bloomington, IL 61701-5783
Phone (309) 663-6564
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019036011 | IL | MD | Dentist |
| 021003464 | IL | MD | Prosthodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Solo Dental Group PLLC | Dentist | Current | Accepting new patients |
Locations
2111 E Oakland Ave
Ste D
Bloomington, IL 61701
Phone (309) 663-6564
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1755129600000",
"number": "1821739749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2111 E OAKLAND AVE STE D",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617015783",
"telephone_number": "309-663-6564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2111 E OAKLAND AVE STE D",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617015783",
"telephone_number": "309-663-6564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOPEZ",
"first_name": "DIANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2025-08-14",
"certification_date": "2025-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019036011",
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "IL",
"license": "021003464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.