Healthcare Provider Details

I. General information

NPI: 1255269437
Provider Name (Legal Business Name): LISA ANGELICI, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18426 BROOKHURST ST STE 204
FOUNTAIN VALLEY CA
92708-6777
US

IV. Provider business mailing address

18426 BROOKHURST ST STE 204
FOUNTAIN VALLEY CA
92708-6777
US

V. Phone/Fax

Practice location:
  • Phone: 714-847-2650
  • Fax: 714-962-7300
Mailing address:
  • Phone: 714-847-2650
  • Fax: 714-962-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LISA ANGELICI
Title or Position: DENTIST
Credential: DMD, MDS
Phone: 714-847-2650