Healthcare Provider Details

I. General information

NPI: 1457683880
Provider Name (Legal Business Name): HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 LOMAS SANTA FE DR SUITE H
SOLANA BEACH CA
92075-1349
US

IV. Provider business mailing address

530 LOMAS SANTA FE DR SUITE H
SOLANA BEACH CA
92075-1349
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-4223
  • Fax: 858-755-3976
Mailing address:
  • Phone: 858-755-4223
  • Fax: 858-755-3976

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: 858-755-4223