Provider Demographics
NPI:1104076363
Name:WARD, ANGELA MARY (RDH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARY
Last Name:WARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 FORT WASHINGTON AVE, 1ST FLOOR
Mailing Address - Street 2:ACN FT. WASHINGTON DENTAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-342-0214
Mailing Address - Fax:
Practice Address - Street 1:99 FORT WASHINGTON AVE, 1ST FLOOR
Practice Address - Street 2:ACN FT. WASHINGTON DENTAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-342-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022157-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist