Provider Demographics
NPI:1235340472
Name:ANDERSON, ANGELA THEODORA (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:THEODORA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:300 RECTOR PL
Mailing Address - Street 2:#5J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1416
Mailing Address - Country:US
Mailing Address - Phone:212-724-8400
Mailing Address - Fax:212-945-6219
Practice Address - Street 1:45 W 54TH ST
Practice Address - Street 2:SUITE #1E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5404
Practice Address - Country:US
Practice Address - Phone:212-724-8400
Practice Address - Fax:212-945-6219
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0449321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics