MEDICARE: DR. SAMUEL JOSEPH ANGULO D.D.S., M.S.

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	1223E0200X	Endodontics	18433	TX
2	1223E0200X	Endodontics	6016	AZ
3	1223E0200X	Endodontics	30081	CA

General Provider Information

NPI Number	:	1407831886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL JOSEPH ANGULO D.D.S., M.S.

Provider Business Mailing Address
First Line	:	7332 REMCON CIR
Second Line	:	SUITE A
City	:	EL PASO
State	:	TX
Zip	:	79912-1623
Country	:	US
Telephone Number	:	915-584-2600
Fax Number	:	915-584-2602

Provider Business Practice Location Address
First Line	:	7332 REMCON CIR
Second Line	:	SUITE A
City	:	EL PASO
State	:	TX
Zip	:	79912-1623
Country	:	US
Telephone Number	:	915-584-2600
Fax Number	:	915-584-2602

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	05/04/2009

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