Individual
JOSE ANGELES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1624 CENTRAL AVE, FAR ROCKAWAY, NY 11691-4002
(718) 845-6223
Mailing address
1624 CENTRAL AVE, FAR ROCKAWAY, NY 11691-4002
(718) 845-6223
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
047628
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02207445
—
NY
Enumeration date
04/23/2007
Last updated
07/08/2007
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