Provider Demographics
NPI:1811077449
Name:ANGELL, DAVID M (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:ANGELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2570
Mailing Address - Country:US
Mailing Address - Phone:920-235-3448
Mailing Address - Fax:
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-236-1680
Practice Address - Fax:920-235-8101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50011991223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI70010800Medicaid
0040023890OtherBLUE CROSS BLUE SHIELD
0040023890OtherBLUE CROSS BLUE SHIELD
WI76090Medicare ID - Type Unspecified