Provider Demographics
NPI:1073729968
Name:ANGELILLO, DENNIS GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GEORGE
Last Name:ANGELILLO
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 1:101 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2017
Mailing Address - Country:US
Mailing Address - Phone:845-358-0060
Mailing Address - Fax:845-358-4783
Practice Address - Street 1:101 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2017
Practice Address - Country:US
Practice Address - Phone:845-358-0060
Practice Address - Fax:845-358-4783
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033658-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0536065Medicare UPIN