Healthcare Provider Details

I. General information

NPI: 1659599710
Provider Name (Legal Business Name): JOHN E ANGELOU D D S PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 ANNAPOLIS RD SUITE A
ODENTON MD
21113-1397
US

IV. Provider business mailing address

1202 ANNAPOLIS RD SUITE A
ODENTON MD
21113-1397
US

V. Phone/Fax

Practice location:
  • Phone: 410-674-4724
  • Fax: 410-551-4237
Mailing address:
  • Phone: 410-674-4724
  • Fax: 410-551-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10026
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN EVANGELOS ANGELOU
Title or Position: DENTIST OWNER
Credential: D.D.S.
Phone: 410-674-4724