Provider Demographics
NPI:1003915810
Name:ANGELICI, LISA MICHELLE (DMD, MDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:ANGELICI
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Gender:F
Credentials:DMD, MDS
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Mailing Address - Street 1:8101 NEWMAN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7042
Mailing Address - Country:US
Mailing Address - Phone:714-847-2650
Mailing Address - Fax:714-847-6614
Practice Address - Street 1:8101 NEWMAN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7042
Practice Address - Country:US
Practice Address - Phone:714-847-2650
Practice Address - Fax:714-847-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA335411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics