Provider Demographics
NPI:1720497324
Name:ANGELA C. CANFIELD DDS PC
Entity Type:Organization
Organization Name:ANGELA C. CANFIELD DDS PC
Other - Org Name:SANDFLY FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CANFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-713-1398
Mailing Address - Street 1:PO BOX 15299
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1999
Mailing Address - Country:US
Mailing Address - Phone:912-713-1398
Mailing Address - Fax:912-826-4825
Practice Address - Street 1:7360 SKIDAWAY RD
Practice Address - Street 2:SUITE H2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-4265
Practice Address - Country:US
Practice Address - Phone:912-713-1398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGELA C CANFIELD DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-07
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty