Provider Demographics
NPI:1427044817
Name:ANGEL, ISAAC (DDS)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:ANGEL
Suffix:
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 1:6068 S APOPKA VINELAND RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4449
Mailing Address - Country:US
Mailing Address - Phone:407-351-6907
Mailing Address - Fax:407-351-6955
Practice Address - Street 1:6068 S APOPKA VINELAND RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4449
Practice Address - Country:US
Practice Address - Phone:407-351-6907
Practice Address - Fax:407-351-6955
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN107001223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN10700OtherBOARD OF DENTISTRY