Healthcare Provider Details

I. General information

NPI: 1811077449
Provider Name (Legal Business Name): DAVID M ANGELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 9TH AVE SUITE 103
OSHKOSH WI
54904-7247
US

IV. Provider business mailing address

1995 HICKORY LN
OSHKOSH WI
54901-2570
US

V. Phone/Fax

Practice location:
  • Phone: 920-236-1680
  • Fax: 920-235-8101
Mailing address:
  • Phone: 920-235-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number5001199
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: