Healthcare Provider Details

I. General information

NPI: 1720645708
Provider Name (Legal Business Name): ANGELA M PELEHAC DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2966 MEADOWLARK LN
ALTOONA WI
54720-2657
US

IV. Provider business mailing address

2966 MEADOWLARK LN
ALTOONA WI
54720-2657
US

V. Phone/Fax

Practice location:
  • Phone: 715-514-3333
  • Fax:
Mailing address:
  • Phone: 715-514-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number100206015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: