MEDICARE: DR. ANGELA STALLARD D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN22269	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013120310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA STALLARD D.M.D.

Provider Business Mailing Address
First Line	:	2930 MAGUIRE RD STE 100
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4750
Country	:	US
Telephone Number	:	407-984-4890
Fax Number	:	407-984-4891

Provider Business Practice Location Address
First Line	:	2930 MAGUIRE RD STE 100
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4750
Country	:	US
Telephone Number	:	407-984-4890
Fax Number	:	407-984-4891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	01/13/2026

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