Provider Demographics
NPI:1265630131
Name:ANGADI, SHAKILA JAGADISH (DDS)
Entity type:Individual
Prefix:MISS
First Name:SHAKILA
Middle Name:JAGADISH
Last Name:ANGADI
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 1:3800 WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5028
Mailing Address - Country:US
Mailing Address - Phone:516-770-3441
Mailing Address - Fax:
Practice Address - Street 1:3800 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5028
Practice Address - Country:US
Practice Address - Phone:516-770-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist