Active NPI
Robert Deangeles, DDS
- Dentist
- Melrose Park, IL
National Provider Identifier
1962756957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19A12294
- Practice address
- 818 N 19TH Ave
Melrose Park, IL 60160-3726 - Phone
- (708) 450-1170
- Fax
- (708) 450-0008
- NPI assigned
- Oct 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19A12294 | IL | Primary |
Addresses
Primary practice location
818 N 19TH Ave
Melrose Park, IL 60160-3726
Mailing address
818 N 19TH Ave
Melrose Park, IL 60160-3726
Phone (708) 450-1170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19A12294 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dimoulis Dental P.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Melrose Park, IL
- NPI 1811362791
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1351555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1351555200000",
"number": "1962756957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "818 N 19TH AVE",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601603726",
"telephone_number": "708-450-1170",
"fax_number": "708-450-0008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "818 N 19TH AVE",
"city": "MELROSE PARK",
"state": "IL",
"postal_code": "601603726",
"telephone_number": "708-450-1170",
"fax_number": "708-450-0008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEANGELES",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-30",
"last_updated": "2012-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "19A12294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melrose Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.