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General NPI Number Information
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NPI Number | 1053798157
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Entity Type | Organization
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Legal Business Name | HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 04/28/2015
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Provider Practice Location Address
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Address Line | 6010 HIDDEN VALLEY RD SUITE #100
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City | CARLSBAD
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State | CA
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Zip | 92011-4213
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Country | US
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Telephone | 760-944-5115
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Fax | 760-944-5226
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Provider Business Mailing Address
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Address Line | 6010 HIDDEN VALLEY RD SUITE #100
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City | CARLSBAD
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State | CA
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Zip | 92011-4213
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Country | US
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Telephone | 760-944-5115
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Fax | 760-944-5226
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Authorized Official
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Title or Position | PARTNER
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Name | DR. CRYSTAL L ANGELOPOULOS
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Credential | DMD
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Telephone | 760-944-5115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 41735
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 52708
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License Number State | CA
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