Provider Demographics
NPI:1215096391
Name:ANGELES, GODOFREDO CASTELO JR (DDS)
Entity type:Individual
Prefix:
First Name:GODOFREDO
Middle Name:CASTELO
Last Name:ANGELES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 WEBB AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-1505
Mailing Address - Country:US
Mailing Address - Phone:818-767-4215
Mailing Address - Fax:818-767-4483
Practice Address - Street 1:8025 WEBB AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-1505
Practice Address - Country:US
Practice Address - Phone:818-767-4215
Practice Address - Fax:818-767-4483
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD46734Medicaid