Provider Demographics
NPI:1720318512
Name:LOUIS A D'ANGELO, DMD, PC
Entity Type:Organization
Organization Name:LOUIS A D'ANGELO, DMD, PC
Other - Org Name:MEDFORD DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-953-7123
Mailing Address - Street 1:103 OLD MARLTON PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8772
Mailing Address - Country:US
Mailing Address - Phone:609-953-7123
Mailing Address - Fax:609-953-1500
Practice Address - Street 1:103 OLD MARLTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-8772
Practice Address - Country:US
Practice Address - Phone:609-953-7123
Practice Address - Fax:609-953-1500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty