Provider Demographics
NPI:1477445955
Name:ANGELA LAITHANGBAM, DDS INC
Entity type:Organization
Organization Name:ANGELA LAITHANGBAM, DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAITHANGBAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-964-5141
Mailing Address - Street 1:505 SOUTH DR STE 1
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4210
Mailing Address - Country:US
Mailing Address - Phone:650-964-5141
Mailing Address - Fax:
Practice Address - Street 1:505 SOUTH DR STE 1
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4210
Practice Address - Country:US
Practice Address - Phone:650-964-5141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental