Healthcare Provider Details

I. General information

NPI: 1245344183
Provider Name (Legal Business Name): ANNE D. ANGLE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 EGYPT ROAD BOX 380
OAKS PA
19456
US

IV. Provider business mailing address

1207 EGYPT ROAD P.O. BOX 380
OAKS PA
19456
US

V. Phone/Fax

Practice location:
  • Phone: 610-650-7775
  • Fax: 610-650-7767
Mailing address:
  • Phone: 610-650-7775
  • Fax: 610-650-7767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS036068
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: