Provider Demographics
NPI:1497977185
Name:MOURADIAN, ANGELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:MOURADIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8533 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5213
Mailing Address - Country:US
Mailing Address - Phone:718-459-3750
Mailing Address - Fax:
Practice Address - Street 1:175 JERICHO TPKE STE 108
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4501
Practice Address - Country:US
Practice Address - Phone:516-364-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist