Provider Demographics
NPI:1689710972
Name:DEANGELIS, ARNOLD RALPH (DDS)
Entity Type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:RALPH
Last Name:DEANGELIS
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 1:445 W JACKSON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-961-5851
Mailing Address - Fax:630-961-5898
Practice Address - Street 1:445 W JACKSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-961-5851
Practice Address - Fax:630-961-5898
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A165521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice