Provider Demographics
NPI:1003088196
Name:ANGULATOS, ED G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ED
Middle Name:G
Last Name:ANGULATOS
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 1:28924 S WESTERN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0814
Mailing Address - Country:US
Mailing Address - Phone:310-832-8309
Mailing Address - Fax:
Practice Address - Street 1:28924 S WESTERN AVE STE 205
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275
Practice Address - Country:US
Practice Address - Phone:310-832-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist