Provider Demographics
NPI:1659386092
Name:ANGELES, JUDITH (DMD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ANGELES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 MERCED ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4212
Mailing Address - Country:US
Mailing Address - Phone:510-940-7997
Mailing Address - Fax:510-940-7996
Practice Address - Street 1:2525 MERCED ST STE A
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4212
Practice Address - Country:US
Practice Address - Phone:510-940-7997
Practice Address - Fax:510-940-7996
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice