MEDICARE: DOMENICK F. D'ANGELICA

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	122300000X	Dentist	23148	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740438787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMENICK F. D'ANGELICA

Provider Business Mailing Address
First Line	:	1425 E GUN HILL RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-3066
Country	:	US
Telephone Number	:	718-671-0480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 E GUN HILL RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-3066
Country	:	US
Telephone Number	:	718-671-0480
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DOMENICK F D'ANGELICA
Credential	:	DDS
Telephone Number	:	718-671-0480

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	09/03/2008

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