Provider Demographics
NPI:1316039555
Name:CANFIELD, ANGELA CHRISTEN (DDS)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:CHRISTEN
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 STONEBRIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419
Mailing Address - Country:US
Mailing Address - Phone:912-341-0403
Mailing Address - Fax:
Practice Address - Street 1:5871 HWY 21 SOUTH
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-826-4037
Practice Address - Fax:912-826-4825
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1748640OtherUNITED CONCORDIA