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General NPI Number Information
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NPI Number | 1104317510
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Entity Type | Individual
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Provider Name | AMELIA K ANGELO DMD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 6036 N NORTHWEST HWY
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City | CHICAGO
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State | IL
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Zip | 60631-2518
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Country | US
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Telephone | 773-377-5658
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 915
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City | PARK RIDGE
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State | IL
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Zip | 60068-0915
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Country | US
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Telephone | 847-845-3473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | PENDING
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 021003052
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License Number State | IL
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