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General NPI Number Information
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NPI Number | 1417655192
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Entity Type | Individual
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Provider Name | ANGELICA BURGOS SACLAYAN DMD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 3340 ROBINWOOD RD # 140
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City | GASTONIA
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State | NC
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Zip | 28054-6689
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Country | US
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Telephone | 704-755-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 2120 DUNAVANT ST APT 330
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City | CHARLOTTE
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State | NC
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Zip | 28203
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Country | US
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Telephone |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 11177
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License Number State | NC
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