MEDICARE: DR. ELLIOT ELI ANGEL 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D2175	AZ

General Provider Information

NPI Number	:	1467699496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOT ELI ANGEL D.M.D.

Provider Business Mailing Address
First Line	:	1819 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4613
Country	:	US
Telephone Number	:	520-458-2500
Fax Number	:	520-452-1876

Provider Business Practice Location Address
First Line	:	1819 PASEO SAN LUIS
Second Line	:
City	:	SIERRA VISTA
State	:	AZ
Zip	:	85635-4613
Country	:	US
Telephone Number	:	520-458-2500
Fax Number	:	520-452-1876

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

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	01/13/2009

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