Provider Demographics
NPI:1184659682
Name:ANGELITA C. LE CRAS, DDS, PA
Entity Type:Organization
Organization Name:ANGELITA C. LE CRAS, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELITA
Authorized Official - Middle Name:CLEOFE
Authorized Official - Last Name:LE CRAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-528-5665
Mailing Address - Street 1:204 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166
Mailing Address - Country:US
Mailing Address - Phone:704-528-5665
Mailing Address - Fax:704-528-5670
Practice Address - Street 1:204 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TROUTMAN
Practice Address - State:NC
Practice Address - Zip Code:28166
Practice Address - Country:US
Practice Address - Phone:704-528-5665
Practice Address - Fax:704-528-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902GUMedicaid