MEDICARE: DR. DOUGLAS NEIL ANGELL 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	2901012982	MI

General Provider Information

NPI Number	:	1467505107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS NEIL ANGELL DDS

Provider Business Mailing Address
First Line	:	755 W BIG BEAVER RD
Second Line	:	SUITE 250
City	:	TROY
State	:	MI
Zip	:	48084-4900
Country	:	US
Telephone Number	:	248-362-4330
Fax Number	:	248-362-4033

Provider Business Practice Location Address
First Line	:	755 W BIG BEAVER RD
Second Line	:	SUITE 250
City	:	TROY
State	:	MI
Zip	:	48084-4900
Country	:	US
Telephone Number	:	248-362-4330
Fax Number	:	248-362-4033

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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