MEDICARE: DR. NARDITO GALANG ANGELES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	55645	CA

General Provider Information

NPI Number	:	1073711420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NARDITO GALANG ANGELES DDS

Provider Business Mailing Address
First Line	:	1635 N MOUNTAIN AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1732
Country	:	US
Telephone Number	:	909-982-2929
Fax Number	:	909-982-8099

Provider Business Practice Location Address
First Line	:	1635 N MOUNTAIN AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1732
Country	:	US
Telephone Number	:	909-982-2929
Fax Number	:	909-982-8099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	08/12/2009

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