Healthcare Provider Details

I. General information

NPI: 1265855969
Provider Name (Legal Business Name): DR. ANDREW PATRICK TRAPANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 MERCHANT DR
ALGONQUIN IL
60102
US

IV. Provider business mailing address

1497 MERCHANT DR
ALGONQUIN IL
60102
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-4020
  • Fax: 847-658-4727
Mailing address:
  • Phone: 847-658-4020
  • Fax: 847-658-4727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-013771
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021-000747
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: