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Export Provider Record NPI 1114376530
Angesom BerheDDS
Active
NPI Number1114376530
NPI TypeNPI-1 Individual
SpecialtyDentist, General Practice
Provider Details
NPI1114376530
NPI TypeNPI-1 Individual
StatusActive
Enumeration Date2016-06-07
Last Updated2016-07-05
Mailing Address350 N Clark St, Ste 600, C/o Kos Services
Chicago, IL 60654
United States
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Primary Practice Address350 N Clark St, Ste 600, C/o Kos Services
Chicago, IL 60654
United States
Phone: (312) 274-4526
📍 View Map
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes1223G0001X – Dentist, General PracticeMI2901022018
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About NPI 1114376530

Angesom Berhe DDS is a healthcare provider registered in the CMS NPPES NPI Registry with NPI number 1114376530. The primary specialty listed is Dentist, General Practice. The provider is located in Chicago, IL. This NPI is classified as a Type 1 (Individual) NPI and is currently active. The NPI was first enumerated (assigned) on 2016-06-07. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1114376530?

NPI 1114376530 belongs to Angesom Berhe DDS, a Dentist, General Practice in Chicago, IL. It is a Type 1 Individual NPI registered in the CMS NPPES NPI Registry.

Is NPI 1114376530 active?

The current status of NPI 1114376530 in the NPPES registry is Active. The record was last updated on 2016-07-05.

What specialty is NPI 1114376530?

NPI 1114376530 is classified under the taxonomy Dentist, General Practice. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1114376530?

You can verify NPI 1114376530 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1114376530?

The primary practice address on file for NPI 1114376530 is 350 N Clark St, Ste 600, Chicago, IL 60654. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1114376530 issued?

NPI 1114376530 was first issued (enumerated) on 2016-06-07. The NPPES record was last updated on 2016-07-05.

Practice Location Map

Angesom Berhe is located at 350 N Clark St, Ste 600, Chicago, IL. Use the map below to find directions or verify the practice location.

📍 350 N Clark St, Ste 600, Chicago, IL 60654  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Angesom Berhe. All records sourced from the CMS NPPES registry.

License Information

The following state license numbers are on file in the NPPES registry for NPI 1114376530. For license status verification, contact the relevant state licensing board directly.

Specialty / TaxonomyLicense NumberState
Dentist, General Practice2901022018MI
Data Verified from CMS NPPES Last synced: 2026-06-27 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162