Healthcare Provider Details

I. General information

NPI: 1508003963
Provider Name (Legal Business Name): ANGELA MICHELLE BRYANT-LECOMPTE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2009
Last Update Date: 03/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7056
  • Fax: 410-605-7819
Mailing address:
  • Phone: 410-605-7056
  • Fax: 410-605-7819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4922
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: