Provider Demographics
NPI:1528199478
Name:SANTAVICCA, ANGELA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JEAN
Last Name:SANTAVICCA
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 1:80 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1620
Mailing Address - Country:US
Mailing Address - Phone:603-448-2750
Mailing Address - Fax:
Practice Address - Street 1:367 STATE ROUTE 120
Practice Address - Street 2:UNIT C
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1430
Practice Address - Country:US
Practice Address - Phone:603-643-4142
Practice Address - Fax:603-643-1740
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2648OtherNH DENTAL LICENSE
NH30310640Medicaid