Healthcare Provider Details

I. General information

NPI: 1124916895
Provider Name (Legal Business Name): ANGELITA GLADYS COLON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 PORTSMOUTH AVE
EXETER NH
03833-2144
US

IV. Provider business mailing address

2 CLAY ST
HOOKSETT NH
03106-2303
US

V. Phone/Fax

Practice location:
  • Phone: 603-377-8989
  • Fax:
Mailing address:
  • Phone: 603-785-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number03690
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: