Healthcare Provider Details

I. General information

NPI: 1700312501
Provider Name (Legal Business Name): ANGELIQUE HA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 S 242ND ST
DES MOINES WA
98198-5166
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 206-212-4520
  • Fax: 206-212-4525
Mailing address:
  • Phone: 206-764-0502
  • Fax: 206-764-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH60677291
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: