Healthcare Provider Details

I. General information

NPI: 1801397666
Provider Name (Legal Business Name): ANGELA WILLOX DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 MAGUIRE RD STE 100
OCOEE FL
34761-4750
US

IV. Provider business mailing address

2407 KILGORE ST
ORLANDO FL
32803-6118
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN22269
License Number StateFL

VIII. Authorized Official

Name: DR. ANGELA WILLOX
Title or Position: PEDIATRIC DENTIST/OWNER
Credential: DMD
Phone: 312-498-8903