Provider Demographics
NPI:1740590645
Name:ANGELA D. DEMOSS, DMD INC.
Entity Type:Organization
Organization Name:ANGELA D. DEMOSS, DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEMOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:937-836-1207
Mailing Address - Street 1:120 W WENGER RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2762
Mailing Address - Country:US
Mailing Address - Phone:937-836-1207
Mailing Address - Fax:
Practice Address - Street 1:120 W WENGER RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2762
Practice Address - Country:US
Practice Address - Phone:937-836-1207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300198181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1265571715OtherINDIVIDUAL NPI