Provider Demographics
NPI:1972564672
Name:ANGULO, JUAN D (DDS)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:D
Last Name:ANGULO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:JUAN
Other - Middle Name:D
Other - Last Name:ANGULO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:41680 IVY STREET, SUITE C
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562
Mailing Address - Country:US
Mailing Address - Phone:951-304-0877
Mailing Address - Fax:951-304-0896
Practice Address - Street 1:41680 IVY STREET, SUITE C
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562
Practice Address - Country:US
Practice Address - Phone:951-304-0877
Practice Address - Fax:951-304-0896
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444531223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice