Provider Demographics
NPI:1952534299
Name:AMEDEO, DAVID M
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:AMEDEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W TALCOTT RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5556
Mailing Address - Country:US
Mailing Address - Phone:847-696-2019
Mailing Address - Fax:847-696-2711
Practice Address - Street 1:2 W TALCOTT RD
Practice Address - Street 2:SUITE 17
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5556
Practice Address - Country:US
Practice Address - Phone:847-696-2019
Practice Address - Fax:847-696-2711
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019018581122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist