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General NPI Number Information
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NPI Number | 1740590645
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Entity Type | Organization
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Legal Business Name | ANGELA D. DEMOSS, DMD INC.
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 120 W WENGER RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2762
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Country | US
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Telephone | 937-836-1207
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W WENGER RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-2762
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Country | US
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Telephone | 937-836-1207
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | ANGELA D DEMOSS
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Credential | DMD
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Telephone | 937-836-1207
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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 | 30019818
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License Number State | OH
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