Provider Demographics
NPI:1699813345
Name:ANGELES, BENJAMIN
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:ANGELES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8694 N HEARTLAND WAY
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5334
Mailing Address - Country:US
Mailing Address - Phone:559-323-5500
Mailing Address - Fax:714-571-3560
Practice Address - Street 1:751 W SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3217
Practice Address - Country:US
Practice Address - Phone:559-323-5500
Practice Address - Fax:559-323-0130
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD51041Medicaid