Provider Demographics
NPI:1235287384
Name:D'ANGELIS-MORRIS, MAGDA CHRISTINA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAGDA
Middle Name:CHRISTINA
Last Name:D'ANGELIS-MORRIS
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 1:620 BARBARY CT.
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027
Mailing Address - Country:US
Mailing Address - Phone:503-742-9069
Mailing Address - Fax:
Practice Address - Street 1:833 S.W. 11TH AVE, SUITE 414
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205
Practice Address - Country:US
Practice Address - Phone:503-221-9439
Practice Address - Fax:503-227-5923
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD76201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice