Healthcare Provider Details

I. General information

NPI: 1104076363
Provider Name (Legal Business Name): ANGELA MARY WARD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 FORT WASHINGTON AVE, 1ST FLOOR ACN FT. WASHINGTON DENTAL
NEW YORK NY
10032
US

IV. Provider business mailing address

99 FORT WASHINGTON AVE, 1ST FLOOR ACN FT. WASHINGTON DENTAL
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-0214
  • Fax:
Mailing address:
  • Phone: 212-342-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number022157-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: