Provider Demographics
NPI:1578972303
Name:AMARANTE, ANDRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:AMARANTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1548
Mailing Address - Country:US
Mailing Address - Phone:224-999-1224
Mailing Address - Fax:224-296-2242
Practice Address - Street 1:2424 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:224-999-1224
Practice Address - Fax:224-296-1224
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029976122300000X, 1223G0001X
IN12012210A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist