Provider Demographics
NPI:1790471183
Name:ANGOLA DENTAL SERVICES, P.C.
Entity Type:Organization
Organization Name:ANGOLA DENTAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-665-5767
Mailing Address - Street 1:205 E HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-7131
Mailing Address - Country:US
Mailing Address - Phone:260-665-5767
Mailing Address - Fax:260-665-8606
Practice Address - Street 1:205 E HARCOURT RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7131
Practice Address - Country:US
Practice Address - Phone:260-665-5767
Practice Address - Fax:260-665-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental