Provider Demographics
NPI:1982616033
Name:SOUTHTOWNS DENTAL SERVICES PC
Entity type:Organization
Organization Name:SOUTHTOWNS DENTAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-825-5020
Mailing Address - Street 1:1497 ABBOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:LACKAWANNA
Mailing Address - State:NY
Mailing Address - Zip Code:14218
Mailing Address - Country:US
Mailing Address - Phone:716-825-5020
Mailing Address - Fax:716-823-7115
Practice Address - Street 1:1497 ABBOTT ROAD
Practice Address - Street 2:
Practice Address - City:LACKAWANNA
Practice Address - State:NY
Practice Address - Zip Code:14218
Practice Address - Country:US
Practice Address - Phone:716-825-5020
Practice Address - Fax:716-823-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY358761122300000X
NY0359351122300000X
NY0410661122300000X
NY1461621122300000X
NY047088122300000X
NY0189991124Q00000X
NY0160431124Q00000X
NY010445124Q00000X
NY0225201124Q00000X
NY0109281124Q00000X
NY0056431124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Single Specialty