Provider Demographics
NPI:1336429612
Name:HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
Entity Type:Organization
Organization Name:HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
Other - Org Name:GREAT SMILES PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGELOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-944-5115
Mailing Address - Street 1:1200 GARDEN VIEW RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2477
Mailing Address - Country:US
Mailing Address - Phone:760-944-5115
Mailing Address - Fax:760-944-5226
Practice Address - Street 1:1200 GARDEN VIEW RD
Practice Address - Street 2:SUITE #102
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2477
Practice Address - Country:US
Practice Address - Phone:760-944-5115
Practice Address - Fax:760-944-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty