Provider Demographics
NPI:1538109996
Name:CICEOVAN, AURORA L (D,D,S)
Entity Type:Individual
Prefix:DR
First Name:AURORA
Middle Name:L
Last Name:CICEOVAN
Suffix:
Gender:F
Credentials:D,D,S
Other - Prefix:DR
Other - First Name:AURORA
Other - Middle Name:L
Other - Last Name:ANGHELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:D,D,S
Mailing Address - Street 1:1530 E DUNDEE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-8301
Mailing Address - Country:US
Mailing Address - Phone:847-358-8080
Mailing Address - Fax:847-358-8095
Practice Address - Street 1:1530 E DUNDEE RD STE 300
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-8301
Practice Address - Country:US
Practice Address - Phone:847-358-8080
Practice Address - Fax:847-358-8095
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190240381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice