Provider Demographics
NPI:1154349686
Name:VEGA, ANGEL AGUSTIN (DDS)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:AGUSTIN
Last Name:VEGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 HARRISON AV NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5349
Mailing Address - Country:US
Mailing Address - Phone:360-943-5551
Mailing Address - Fax:360-709-9537
Practice Address - Street 1:1320 HARRISON AV NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5349
Practice Address - Country:US
Practice Address - Phone:360-943-5551
Practice Address - Fax:360-709-9537
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist