Provider Demographics
NPI:1770601650
Name:ANGELO, PATRICK J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:ANGELO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1062
Mailing Address - Country:US
Mailing Address - Phone:708-366-2180
Mailing Address - Fax:708-366-2194
Practice Address - Street 1:7777 NORTH AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1062
Practice Address - Country:US
Practice Address - Phone:708-366-2180
Practice Address - Fax:708-366-2194
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics