Provider Demographics
NPI:1194984195
Name:ANGELO, SALVATORE II (DMD)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:
Last Name:ANGELO
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 CENTRE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1553
Mailing Address - Country:US
Mailing Address - Phone:617-969-7890
Mailing Address - Fax:617-964-2765
Practice Address - Street 1:1280 CENTRE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1553
Practice Address - Country:US
Practice Address - Phone:617-969-7890
Practice Address - Fax:617-964-2765
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice