Provider Demographics
NPI:1053798157
Name:HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
Entity type:Organization
Organization Name:HYDO, ANGELOPOULOS & MILLER DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGELOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-944-5115
Mailing Address - Street 1:6010 HIDDEN VALLEY RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4213
Mailing Address - Country:US
Mailing Address - Phone:760-944-5115
Mailing Address - Fax:760-944-5226
Practice Address - Street 1:6010 HIDDEN VALLEY RD
Practice Address - Street 2:SUITE #100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4213
Practice Address - Country:US
Practice Address - Phone:760-944-5115
Practice Address - Fax:760-944-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA527081223P0221X
CA417351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty