Individual provider Active NPI

George M Angelos, DMD

  • Pediatric Dentistry
  • Harlingen, TX
National Provider Identifier
1013068055
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
17313 Issued in TX
Practice address
1717 E Harrison Ave
Harlingen, TX 78550-7389
Phone
(956) 428-2221
Fax
(956) 423-4492
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X 17313 TX Primary

Addresses

Primary practice location

1717 E Harrison Ave
Harlingen, TX 78550-7389

Mailing address

1717 E Harrison Ave
Harlingen, TX 78550-7389
Phone (956) 428-2221

Other identifiers 1

IdentifierTypeStateIssuer
126730402MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
17313TXMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
The Children'S Dentist Pediatric Dentistry Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1013068055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 E HARRISON AVE",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785507389",
            "telephone_number": "956-428-2221",
            "fax_number": "956-423-4492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 E HARRISON AVE",
            "city": "HARLINGEN",
            "state": "TX",
            "postal_code": "785507389",
            "telephone_number": "956-428-2221",
            "fax_number": "956-423-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANGELOS",
        "first_name": "GEORGE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "17313",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126730402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Harlingen, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.