Phillip John D'Angelo, D.D.S.
Individual provider Active NPI General Practice Dentistry · Willits, CA
NPI 1689765356 · NPPES record last updated Mar 15, 2024
Key facts
- NPI
- 1689765356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 44158 (CA)
- Practice address
- 61 S Humboldt St
Willits, CA 95490-3509 - Phone
- (707) 459-4664
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 44158 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Round Valley Indian Health Center, Inc. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 44158 | CA | Yes |
Addresses
Primary practice location
61 S Humboldt St
Willits, CA 95490-3509
Mailing address
61 S Humboldt St
Willits, CA 95490-3509
Phone (707) 459-4664
Other practice location 1
24065 Biggar lane
Covelo, CA 95428-0247
Phone (707) 983-6181
Other providers in Willits, CA
- Tasha Justine Craig
- Jeff A Cramer
- Melissa M Cramer
- Constance Susan Criswell
- Jared Edan Cruz
- Erica D'Anis
- Matthew D'Anis
- Brad Daniel
- Suraya David-Sadira
- Jeremiah Reed Holmes Dawson
All providers in Willits, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 15, 2024. 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.