Provider Demographics
NPI:1851326359
Name:LECRAS, ANGELITA CLEOFE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELITA
Middle Name:CLEOFE
Last Name:LECRAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TROUTMAN
Mailing Address - State:NC
Mailing Address - Zip Code:28166
Mailing Address - Country:US
Mailing Address - Phone:704-528-5665
Mailing Address - Fax:704-528-5670
Practice Address - Street 1:204 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:TROUTMAN
Practice Address - State:NC
Practice Address - Zip Code:28166
Practice Address - Country:US
Practice Address - Phone:704-528-5665
Practice Address - Fax:704-528-5670
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902GUMedicaid