Provider Demographics
NPI:1518375211
Name:ANGELA SKIDMORE DDS PC
Entity Type:Organization
Organization Name:ANGELA SKIDMORE DDS PC
Other - Org Name:BARTLETT DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:BOGACKI
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-289-4288
Mailing Address - Street 1:988 S BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-6500
Mailing Address - Country:US
Mailing Address - Phone:630-289-4288
Mailing Address - Fax:630-289-4468
Practice Address - Street 1:988 S BARTLETT RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-6500
Practice Address - Country:US
Practice Address - Phone:630-289-4288
Practice Address - Fax:630-289-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025896122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty