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NPI Code Detail

MEDICARE: DR. ANGELO N STAMOS DMD

MEDICARE: DR. ANGELO N STAMOS DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryIL

General Provider Information

NPI Number : 1174686588
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELO N STAMOS DMD
Provider Business Mailing Address
First Line : 7815 GOLF RD
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-1039
Country : US
Telephone Number : 847-470-9740
Fax Number :
Provider Business Practice Location Address
First Line : 3240 W FRANKLIN BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60624-1511
Country : US
Telephone Number : 773-722-3020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2006
Last Update Date : 07/08/2007

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