Healthcare Provider Details

I. General information

NPI: 1336429612
Provider Name (Legal Business Name): HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GARDEN VIEW RD SUITE #102
ENCINITAS CA
92024-2477
US

IV. Provider business mailing address

1200 GARDEN VIEW RD SUITE #102
ENCINITAS CA
92024-2477
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

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