Mark Christopher Angiolillo, DDS
Individual provider Active NPI Dentist · Clintondale, NY
NPI 1023213618 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1023213618
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 052882 (NY)
- Practice address
- 4 Applewood CT
Clintondale, NY 12515-5100 - Phone
- (845) 883-8732
- NPI assigned
- Jun 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052882 | NY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 052882 | NY | Yes |
Addresses
Primary practice location
4 Applewood CT
Clintondale, NY 12515-5100
Mailing address
4 Applewood Court
Clintondale, NY 12515
Phone (845) 883-8732
Other providers in Clintondale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.