Provider Demographics
NPI:1245319698
Name:BARBAGALLO, MARGUERITE ANGELA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:ANGELA
Last Name:BARBAGALLO
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 1:460 COVENTRY LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7561
Mailing Address - Country:US
Mailing Address - Phone:815-459-3100
Mailing Address - Fax:815-459-6794
Practice Address - Street 1:460 COVENTRY LN
Practice Address - Street 2:SUITE 202
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7561
Practice Address - Country:US
Practice Address - Phone:815-459-3100
Practice Address - Fax:815-459-6794
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice