Provider Demographics
NPI:1457576795
Name:ANGELES & MORALES D.D.S.,P.C.
Entity Type:Organization
Organization Name:ANGELES & MORALES D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-471-5543
Mailing Address - Street 1:12511 111TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1509
Mailing Address - Country:US
Mailing Address - Phone:718-845-6223
Mailing Address - Fax:718-738-1744
Practice Address - Street 1:12511 111TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1509
Practice Address - Country:US
Practice Address - Phone:718-845-6223
Practice Address - Fax:718-738-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0476281223G0001X
NY0473071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01975680Medicaid
NY02207445Medicaid