MEDICARE: DR. ANGELA M PELEHAC DDS, MSD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	100206015	WI

General Provider Information

NPI Number	:	1720645708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA M PELEHAC DDS, MSD

Provider Business Mailing Address
First Line	:	2966 MEADOWLARK LN
Second Line	:
City	:	ALTOONA
State	:	WI
Zip	:	54720-2657
Country	:	US
Telephone Number	:	715-514-3333
Fax Number	:

Provider Business Practice Location Address
First Line	:	2966 MEADOWLARK LN
Second Line	:
City	:	ALTOONA
State	:	WI
Zip	:	54720-2657
Country	:	US
Telephone Number	:	715-514-3333
Fax Number	:

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

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	09/04/2024

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