Provider Demographics
NPI:1881047843
Name:ANGELONI, MARK DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DANIEL
Last Name:ANGELONI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MORSE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4259
Mailing Address - Country:US
Mailing Address - Phone:407-794-0739
Mailing Address - Fax:
Practice Address - Street 1:400 W MORSE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4259
Practice Address - Country:US
Practice Address - Phone:407-794-0739
Practice Address - Fax:407-794-0740
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT116351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics