MEDICARE: ANGELA WILLOX DMD LLC

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	1223P0221X	Pediatric Dentistry	DN22269	FL

General Provider Information

NPI Number	:	1801397666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELA WILLOX DMD LLC

Provider Business Mailing Address
First Line	:	2407 KILGORE ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-6118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2930 MAGUIRE RD STE 100
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4750
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC DENTIST/OWNER
Name	:	DR. ANGELA WILLOX
Credential	:	DMD
Telephone Number	:	312-498-8903

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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