Provider Demographics
NPI:1447468178
Name:VALCARENGHI, IVAN (DDS)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:VALCARENGHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W BUTTERFIELD RD STE 230
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5000
Mailing Address - Country:US
Mailing Address - Phone:630-834-8088
Mailing Address - Fax:630-834-8091
Practice Address - Street 1:360 W BUTTERFIELD RD STE 230
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5000
Practice Address - Country:US
Practice Address - Phone:630-834-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020242122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400480643OtherMEDICARE PTAN