Provider Demographics
NPI:1831493568
Name:EMMANUEL ANGELES DDS, INC
Entity Type:Organization
Organization Name:EMMANUEL ANGELES DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:DE GUZMAN
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-925-4466
Mailing Address - Street 1:9824 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5906
Mailing Address - Country:US
Mailing Address - Phone:562-925-4466
Mailing Address - Fax:562-925-4466
Practice Address - Street 1:9824 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5906
Practice Address - Country:US
Practice Address - Phone:562-925-4466
Practice Address - Fax:562-925-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55644302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization