Healthcare Provider Details

I. General information

NPI: 1053798157
Provider Name (Legal Business Name): HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 HIDDEN VALLEY RD SUITE #100
CARLSBAD CA
92011-4213
US

IV. Provider business mailing address

6010 HIDDEN VALLEY RD SUITE #100
CARLSBAD CA
92011-4213
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-5115
  • Fax: 760-944-5226
Mailing address:
  • Phone: 760-944-5115
  • Fax: 760-944-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number52708
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number41735
License Number StateCA

VIII. Authorized Official

Name: DR. CRYSTAL L ANGELOPOULOS
Title or Position: PARTNER
Credential: DMD
Phone: 760-944-5115