Individual
ANGELINA ALEKSEEVNA MITIANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1324 SE 17TH ST, FORT LAUDERDALE, FL 33316-1708
(954) 998-3527
Mailing address
1324 SE 17TH ST, FORT LAUDERDALE, FL 33316-1708
(305) 440-8694
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN30997
FL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MA
Other
Enumeration date
03/03/2025
Last updated
05/28/2026
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