Provider Demographics
NPI:1912357229
Name:ANGERAME, THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:ANGERAME
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 1:124 E PALATINE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-5110
Mailing Address - Country:US
Mailing Address - Phone:847-358-4090
Mailing Address - Fax:847-358-4094
Practice Address - Street 1:124 E PALATINE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067
Practice Address - Country:US
Practice Address - Phone:847-359-4090
Practice Address - Fax:847-358-4094
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030705122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019030705OtherGENERAL DENTIST