Provider Demographics
NPI:1689014714
Name:CANGELOSI, RICHARD G (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:CANGELOSI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-9671
Mailing Address - Country:US
Mailing Address - Phone:225-292-3456
Mailing Address - Fax:225-291-2167
Practice Address - Street 1:4220 BLUEBONNET BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9671
Practice Address - Country:US
Practice Address - Phone:225-292-3456
Practice Address - Fax:225-291-2167
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice