Provider Demographics
NPI:1043396450
Name:ANGELIDIS, ANASTASIOS S (DDS MS)
Entity Type:Individual
Prefix:
First Name:ANASTASIOS
Middle Name:S
Last Name:ANGELIDIS
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 NORTH ROXBURY DRIVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-777-8382
Mailing Address - Fax:310-777-8397
Practice Address - Street 1:436 NORTH ROXBURY DRIVE
Practice Address - Street 2:SUITE 211
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-777-8382
Practice Address - Fax:310-777-8397
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics