Provider Demographics
NPI:1811336647
Name:NEGLIA, MICHAEL MAURO (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MAURO
Last Name:NEGLIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-2719
Mailing Address - Country:US
Mailing Address - Phone:815-895-2298
Mailing Address - Fax:
Practice Address - Street 1:645 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-2719
Practice Address - Country:US
Practice Address - Phone:815-895-2298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10012771223G0001X
CA624401223G0001X
IL019.0323631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice