Provider Demographics
NPI:1629007976
Name:FROGAMENI, DEBORAH (DDS)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:FROGAMENI
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 1:1701 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-5646
Mailing Address - Country:US
Mailing Address - Phone:312-666-3494
Mailing Address - Fax:312-666-6228
Practice Address - Street 1:5215 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7014
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:312-666-6228
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0180171223G0001X
IL019-0217441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019021744Medicaid
OH2219281Medicaid
OH600972OtherBUCKEYE GROUP ID
OH10246OtherGROUP PARAMOUNT ID
OH8822331Medicaid
OH109100OtherDORAL DENTAL
OH88333OHOtherDELTA DENTAL