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General NPI Number Information
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NPI Number | 1568072692
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Entity Type | Individual
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Provider Name | ANGELA PANAGOS DDS
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Gender | Female
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Dates
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Enumeration Date | 08/04/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 18501 MACK AVE
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City | GROSSE POINTE
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State | MI
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Zip | 48236-3224
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Country | US
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Telephone | 313-820-5730
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Fax |
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Provider Business Mailing Address
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Address Line | 20006 HOLIDAY RD
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City | GROSSE POINTE WOODS
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State | MI
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Zip | 48236-2372
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Country | US
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Telephone | 313-820-5730
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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 | 2901600673
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License Number State | MI
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