Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 17313 | TX |
NPI | 1013068055 |
---|---|
Provider Name | Dr. George M Angelos |
First Address | Harlingen, TX 78550-7389 |
Second Address | Harlingen, TX 78550-7389 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 17/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126730402 | (05) | TX |