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General NPI Number Information
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NPI Number | 1063176204
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Entity Type | Individual
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Provider Name | ISE D'ANGELO DMD
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Gender | Female
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 3110 NIEDER RD
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City | LAWRENCE
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State | KS
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Zip | 66047-1950
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Country | US
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Telephone | 815-289-7615
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Fax |
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Provider Business Mailing Address
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Address Line | 50 E 13TH ST UNIT 1904
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City | KANSAS CITY
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State | MO
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Zip | 64106-2947
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Country | US
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Telephone | 815-289-7615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61972
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License Number State | KS
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