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General NPI Number Information
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NPI Number | 1700043148
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Entity Type | Organization
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Legal Business Name | SAMUEL J. DEANGELO
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 1142 EXECUTIVE CIR B
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City | CARY
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State | NC
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Zip | 27511-4570
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Country | US
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Telephone | 919-467-3213
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Fax | 919-467-3246
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Provider Business Mailing Address
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Address Line | 1142 EXECUTIVE CIR B
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City | CARY
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State | NC
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Zip | 27511-4570
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Country | US
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Telephone | 919-467-3213
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Fax | 919-467-3246
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. SAMUEL JOHN DEANGELO
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Credential | DDS
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Telephone | 919-467-3213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 7596
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License Number State | NC
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