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General NPI Number Information
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NPI Number | 1265647549
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Entity Type | Individual
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Provider Name | ANGELA LOUISE KING RDH
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1033 EAST WILCOX AVE.
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City | WHITE CLOUD
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State | MI
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Zip | 49349
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Country | US
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Telephone | 231-689-6651
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Fax |
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Provider Business Mailing Address
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Address Line | 828 N 4TH AVE
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City | BIG RAPIDS
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State | MI
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Zip | 49307-1130
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Country | US
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Telephone | 231-598-2021
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902012464
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License Number State | MI
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