Healthcare Provider Details

I. General information

NPI: 1316691967
Provider Name (Legal Business Name): MONICA ANGELUCCI DMD, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W UWCHLAN AVE
EXTON PA
19341-3010
US

IV. Provider business mailing address

1301 BROAD RUN RD
LANDENBERG PA
19350-1348
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-2200
  • Fax:
Mailing address:
  • Phone: 484-643-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS043068
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: