Provider Demographics
NPI:1689093767
Name:ADAMES, ANGELINA M (DDS)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:M
Last Name:ADAMES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:MIOSOTIS
Other - Last Name:GOMEZ TEJADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3601 NW 107TH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4377
Mailing Address - Country:US
Mailing Address - Phone:305-418-7771
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 107TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4377
Practice Address - Country:US
Practice Address - Phone:305-418-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 211191223G0001X
NY058293-11223G0001X
390200000X
FLDN21119390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice