Provider Demographics
NPI:1699822056
Name:CANGELOSI, JOSEPH CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHRISTOPHER
Last Name:CANGELOSI
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 1:900 S CEDAR ST.
Mailing Address - Street 2:PO BOX 26
Mailing Address - City:BISMARCK
Mailing Address - State:MO
Mailing Address - Zip Code:63624-0026
Mailing Address - Country:US
Mailing Address - Phone:573-734-6082
Mailing Address - Fax:573-734-6145
Practice Address - Street 1:900 S CEDAR ST.
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:MO
Practice Address - Zip Code:63624-0026
Practice Address - Country:US
Practice Address - Phone:573-734-6082
Practice Address - Fax:573-734-6145
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0137451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice