Provider Demographics
NPI:1649262163
Name:MCDONOUGH, ANGELA M (DMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:DELLISANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5134 JUDSON DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3849
Mailing Address - Country:US
Mailing Address - Phone:267-523-5919
Mailing Address - Fax:
Practice Address - Street 1:DENTAL DEPARTMENT BUILDING 137
Practice Address - Street 2:NHC WILLOW GROVE
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:10909
Practice Address - Country:US
Practice Address - Phone:215-443-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0354641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice