Healthcare Provider Details

I. General information

NPI: 1982121455
Provider Name (Legal Business Name): ANGELA HALL-MORRIS PUBLIC HEALTH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 08/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N 11TH ST
PHILADELPHIA PA
19123-1957
US

IV. Provider business mailing address

2409 BRYN MAWR AVE
PHILADELPHIA PA
19131-1410
US

V. Phone/Fax

Practice location:
  • Phone: 215-769-1594
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH000663
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: