Provider Demographics
NPI:1023213618
Name:ANGIOLILLO, MARK CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:ANGIOLILLO
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 1:4 APPLEWOOD COURT
Mailing Address - Street 2:
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515
Mailing Address - Country:US
Mailing Address - Phone:845-883-8732
Mailing Address - Fax:
Practice Address - Street 1:4 APPLEWOOD CT
Practice Address - Street 2:
Practice Address - City:CLINTONDALE
Practice Address - State:NY
Practice Address - Zip Code:12515-5100
Practice Address - Country:US
Practice Address - Phone:845-883-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052882122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist