Provider Demographics
NPI:1942651971
Name:BOEGE, CAROLINA ANG (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:ANG
Last Name:BOEGE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:LIN
Other - Last Name:ANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:740 S FEDERAL ST
Mailing Address - Street 2:#1004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1832
Mailing Address - Country:US
Mailing Address - Phone:630-709-3843
Mailing Address - Fax:
Practice Address - Street 1:3514 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1104
Practice Address - Country:US
Practice Address - Phone:773-929-4140
Practice Address - Fax:773-929-2514
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist