Healthcare Provider Details

I. General information

NPI: 1194652701
Provider Name (Legal Business Name): ANGELA DENT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4612 STONEY CREEK PKWY
CHESTER VA
23831-6739
US

IV. Provider business mailing address

4612 STONEY CREEK PKWY
CHESTER VA
23831-6739
US

V. Phone/Fax

Practice location:
  • Phone: 956-975-0139
  • Fax:
Mailing address:
  • Phone: 956-975-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002104899
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: