Provider Demographics
NPI:1598188187
Name:FALLETTA, ANGELA (RDH)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:FALLETTA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ENTERPRISE
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-6028
Mailing Address - Country:US
Mailing Address - Phone:949-235-4961
Mailing Address - Fax:
Practice Address - Street 1:2 ENTERPRISE
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-6028
Practice Address - Country:US
Practice Address - Phone:949-235-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-02
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26629124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist