Provider Demographics
NPI:1043328453
Name:LILIBETH AYANGCO DMD PA
Entity Type:Organization
Organization Name:LILIBETH AYANGCO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIBETH
Authorized Official - Middle Name:
Authorized Official - Last Name:AYANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:954-427-5700
Mailing Address - Street 1:1500 E HILLSBORO BLVD
Mailing Address - Street 2:#101
Mailing Address - City:DEERFIELD BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:954-427-5700
Mailing Address - Fax:954-427-5990
Practice Address - Street 1:1500 E HILLSBORO BLVD
Practice Address - Street 2:#101
Practice Address - City:DEERFIELD BCH
Practice Address - State:FL
Practice Address - Zip Code:33441
Practice Address - Country:US
Practice Address - Phone:954-427-5700
Practice Address - Fax:954-427-5990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15095122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV15095OtherBCBS