Provider Demographics
NPI:1245830900
Name:ROSADO MENCIA, ANGEL FELIX
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:FELIX
Last Name:ROSADO MENCIA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STANDISH RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3816
Mailing Address - Country:US
Mailing Address - Phone:978-882-1919
Mailing Address - Fax:
Practice Address - Street 1:2990 GRANDEVILLE CIR APT 3-202
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6070
Practice Address - Country:US
Practice Address - Phone:978-882-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL14456122300000X
FLDN296951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist