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General NPI Number Information
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NPI Number | 1255959920
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Entity Type | Individual
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Provider Name | ANGELA MARIE WALTER HAGEN DMD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 2228 STATE HILL RD
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City | WYOMISSING
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State | PA
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Zip | 19610-1904
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Country | US
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Telephone | 610-379-3494
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Fax |
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Provider Business Mailing Address
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Address Line | 3117 ASHLEY LN
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City | SINKING SPRING
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State | PA
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Zip | 19608-1056
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Country | US
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Telephone | 610-406-2995
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS042787
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS042787
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License Number State | PA
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