Provider Demographics
NPI:1699772814
Name:FENNELL, ANGELA SAINT (DMD)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SAINT
Last Name:FENNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:R
Other - Last Name:SAINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:4000 BALMORAL DR SW
Mailing Address - Street 2:STE 102
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6402
Mailing Address - Country:US
Mailing Address - Phone:256-880-8436
Mailing Address - Fax:256-880-8325
Practice Address - Street 1:4000 BALMORAL DR SW
Practice Address - Street 2:STE 102
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6402
Practice Address - Country:US
Practice Address - Phone:256-880-8436
Practice Address - Fax:256-880-8325
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
831591OtherTRICARE
AL90832OtherBCBS
831591OtherUNITED CONCORD