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General NPI Number Information
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NPI Number | 1699337139
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Entity Type | Individual
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Provider Name | ANGELA LO DMD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2019
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Last Update Date | 08/30/2020
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Provider Practice Location Address
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Address Line | 65 JAMES ST
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City | EDISON
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State | NJ
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Zip | 08820-3903
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Country | US
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Telephone | 732-321-7608
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Fax |
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Provider Business Mailing Address
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Address Line | 44 BAYBERRY CLOSE
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City | PISCATAWAY
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State | NJ
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Zip | 08854-5924
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Country | US
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Telephone | 732-853-2701
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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 | 22DR03426
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02801300
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License Number State | NJ
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