Provider Demographics
NPI:1790843399
Name:VENEGONI, ANGELA PLANER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:PLANER
Last Name:VENEGONI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 5TH AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3403
Mailing Address - Country:US
Mailing Address - Phone:630-369-6836
Mailing Address - Fax:630-369-7067
Practice Address - Street 1:300 E 5TH AVE STE 420
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3403
Practice Address - Country:US
Practice Address - Phone:630-369-6836
Practice Address - Fax:630-369-7067
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IL0190253481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV06059Medicare UPIN
IL7306420001Medicare NSC