Provider Demographics
NPI:1992979207
Name:ANGELL FAMILY DENTISTRY, P.A.
Entity type:Organization
Organization Name:ANGELL FAMILY DENTISTRY, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANGELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-788-2215
Mailing Address - Street 1:423 40TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-3719
Mailing Address - Country:US
Mailing Address - Phone:763-788-2215
Mailing Address - Fax:763-788-1199
Practice Address - Street 1:423 40TH AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-3719
Practice Address - Country:US
Practice Address - Phone:763-788-2215
Practice Address - Fax:763-788-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN824317OtherUNITED CONCORDIA
MN00552ANOtherBLUE CROSS/BLUE SHIELD
MN7130180-00OtherMEDICAL ASSISTANCE
MN9927OtherDORAL
MN9927OtherDORAL