Provider Demographics
NPI:1649239195
Name:BAGDADE, CHARLES J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:BAGDADE
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 1:125 E TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1424
Mailing Address - Country:US
Mailing Address - Phone:847-367-4890
Mailing Address - Fax:847-367-4891
Practice Address - Street 1:125 E TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1424
Practice Address - Country:US
Practice Address - Phone:847-367-4890
Practice Address - Fax:847-367-4891
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0137231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice