Provider Demographics
NPI:1417499955
Name:ANGUS, NATHAN (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:ANGUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 OPAL LN
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4663
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 ERIE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2519
Practice Address - Country:US
Practice Address - Phone:303-828-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002028521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice