Provider Demographics
NPI:1962532457
Name:DR. ALTHEA ANGEL, P.C.
Entity type:Organization
Organization Name:DR. ALTHEA ANGEL, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCELWAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:647-350-7474
Mailing Address - Street 1:185 DEVONSHIRE ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-1407
Mailing Address - Country:US
Mailing Address - Phone:617-350-7474
Mailing Address - Fax:617-350-7373
Practice Address - Street 1:185 DEVONSHIRE ST
Practice Address - Street 2:SUITE 410
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1407
Practice Address - Country:US
Practice Address - Phone:617-350-7474
Practice Address - Fax:617-350-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty