Provider Demographics
NPI:1538378559
Name:DIMITREY, ANGELE F (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELE
Middle Name:F
Last Name:DIMITREY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5416
Mailing Address - Country:US
Mailing Address - Phone:201-963-0807
Mailing Address - Fax:
Practice Address - Street 1:1659 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1570
Practice Address - Country:US
Practice Address - Phone:718-983-6300
Practice Address - Fax:516-822-2396
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0477501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01892286Medicaid