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General NPI Number Information
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NPI Number | 1861065062
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Entity Type | Individual
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Provider Name | ANDREA CAROLINA ANGULO
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Gender | Female
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 2228 N DOWNING RD
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City | ANGLETON
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State | TX
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Zip | 77515-3710
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Country | US
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Telephone | 979-291-0952
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Fax |
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Provider Business Mailing Address
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Address Line | 3106 MILLBROOK DR
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City | PEARLAND
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State | TX
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Zip | 77584-3118
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 37639
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License Number State | TX
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