David M Angell, DDS

Individual provider Active NPI Oral and Maxillofacial Pathology Dentistry · Oshkosh, WI

NPI 1811077449 · NPPES record last updated Sep 5, 2007

Key facts

NPI
1811077449
Entity type
Individual (NPI type 1)
Primary specialty
Oral and Maxillofacial Pathology Dentistry 1223P0106X
License
5001199 (WI)
Practice address
2700 W 9TH Ave
Suite 103
Oshkosh, WI 54904-7247
Phone
(920) 236-1680
Fax
(920) 235-8101
NPI assigned
Oct 17, 2006
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)
Yes

State licenses

LicenseStateTypeSpecialty
5001199WIMDOral and Maxillofacial Pathology Dentist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Pathology Dentistry 1223P0106X 5001199 WI Yes

Addresses

Primary practice location

2700 W 9TH Ave
Suite 103
Oshkosh, WI 54904-7247

Mailing address

1995 Hickory LN
Oshkosh, WI 54901-2570
Phone (920) 235-3448

Other identifiers

IdentifierTypeStateIssuer
70010800MedicaidWI
0040023890OtherBLUE CROSS BLUE SHIELD

Other providers in Oshkosh, WI

All providers in Oshkosh, WI · Oral and Maxillofacial Pathology Dentistry in Wisconsin

Sources for this page

Verify at the official NPI Registry.