Provider Demographics
NPI:1043418676
Name:ROLDAN-WHITAKER, ANGELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:ROLDAN-WHITAKER
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 1:5501 MARVIN SHIELDS BLVD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-9007
Mailing Address - Country:US
Mailing Address - Phone:228-871-2605
Mailing Address - Fax:228-871-2864
Practice Address - Street 1:NAVAL HOSPITAL PENSACOLA
Practice Address - Street 2:6000 WEST HIGHWAY 98
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-0003
Practice Address - Country:US
Practice Address - Phone:228-871-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA104348676OtherMILITARY