Provider Demographics
NPI:1568871135
Name:BERNEDO PANTIGOZO, ANGELA DANIELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DANIELA
Last Name:BERNEDO PANTIGOZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CALABRIA DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6005
Mailing Address - Country:US
Mailing Address - Phone:213-915-1848
Mailing Address - Fax:
Practice Address - Street 1:15159 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-5705
Practice Address - Country:US
Practice Address - Phone:213-915-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002023341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice