Provider Demographics
NPI:1700043148
Name:SAMUEL J. DEANGELO
Entity Type:Organization
Organization Name:SAMUEL J. DEANGELO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DEANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-467-3213
Mailing Address - Street 1:1142 EXECUTIVE CIR
Mailing Address - Street 2:B
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4570
Mailing Address - Country:US
Mailing Address - Phone:919-467-3213
Mailing Address - Fax:919-467-3246
Practice Address - Street 1:1142 EXECUTIVE CIR
Practice Address - Street 2:B
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4570
Practice Address - Country:US
Practice Address - Phone:919-467-3213
Practice Address - Fax:919-467-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7596261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental