Healthcare Provider Details

I. General information

NPI: 1033478375
Provider Name (Legal Business Name): ANGELO GAYHEART POPE JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 OLNEY SANDY SPRING RD
ASHTON MD
20861-3656
US

IV. Provider business mailing address

42152 SANDOWN PARK TER
ALDIE VA
20105-5807
US

V. Phone/Fax

Practice location:
  • Phone: 850-212-6919
  • Fax:
Mailing address:
  • Phone: 850-212-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401415004
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15538
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: