Provider Demographics
NPI:1760564991
Name:DAMORE, TONI L (BS RDHMED)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:L
Last Name:DAMORE
Suffix:
Gender:F
Credentials:BS RDHMED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1973 ALPINE CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1782
Mailing Address - Country:US
Mailing Address - Phone:847-662-2044
Mailing Address - Fax:
Practice Address - Street 1:1160 PARK AVE W
Practice Address - Street 2:SUITE 6E
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2230
Practice Address - Country:US
Practice Address - Phone:847-433-0320
Practice Address - Fax:847-433-5952
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist