Provider Demographics
NPI:1063176204
Name:D'ANGELO, ISE (DMD)
Entity type:Individual
Prefix:
First Name:ISE
Middle Name:
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 E 13TH ST UNIT 1904
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2947
Mailing Address - Country:US
Mailing Address - Phone:815-289-7615
Mailing Address - Fax:
Practice Address - Street 1:3110 NIEDER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1950
Practice Address - Country:US
Practice Address - Phone:815-289-7615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist