Provider Demographics
NPI:1265526727
Name:DEFABRIQUE, ANGELA (DMD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DEFABRIQUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BUITRAGO-DEFABRIQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1019 N STATE ROAD 7
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5100
Mailing Address - Country:US
Mailing Address - Phone:561-422-3360
Mailing Address - Fax:561-422-3233
Practice Address - Street 1:1019 N STATE ROAD 7
Practice Address - Street 2:SUITE A
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5100
Practice Address - Country:US
Practice Address - Phone:561-422-3360
Practice Address - Fax:561-422-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 158071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics