Provider Demographics
NPI:1104866359
Name:DEANGELO, DANIEL M (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:DEANGELO
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:827 MCKAY COURT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512
Mailing Address - Country:US
Mailing Address - Phone:330-758-1188
Mailing Address - Fax:330-758-0532
Practice Address - Street 1:827 MCKAY CT
Practice Address - Street 2:SUITE 1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5790
Practice Address - Country:US
Practice Address - Phone:330-758-1188
Practice Address - Fax:330-758-0532
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH30 01 83251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics