Provider Demographics
NPI:1609654953
Name:AMATANGELO, ANGELICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELICA
Middle Name:
Last Name:AMATANGELO
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 1:120 CONNECTICUT ST APT C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2483
Mailing Address - Country:US
Mailing Address - Phone:412-853-2303
Mailing Address - Fax:
Practice Address - Street 1:1800 MARKET ST STE 401
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6227
Practice Address - Country:US
Practice Address - Phone:415-292-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS109172122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist