Provider Demographics
NPI:1124580477
Name:SAYOC, ANGELA CLAIRE (DMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:CLAIRE
Last Name:SAYOC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 KINGSLEY AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-9203
Mailing Address - Country:US
Mailing Address - Phone:904-215-2199
Mailing Address - Fax:
Practice Address - Street 1:1555 KINGSLEY AVE STE 306
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-9203
Practice Address - Country:US
Practice Address - Phone:904-215-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN246761223G0001X
CT1124580477390200000X
CT12512390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice