Provider Demographics
NPI:1467699496
Name:ANGEL, ELLIOT ELI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:ELI
Last Name:ANGEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 PASEO SAN LUIS
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4613
Mailing Address - Country:US
Mailing Address - Phone:520-458-2500
Mailing Address - Fax:520-452-1876
Practice Address - Street 1:1819 PASEO SAN LUIS
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4613
Practice Address - Country:US
Practice Address - Phone:520-458-2500
Practice Address - Fax:520-452-1876
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD21751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics