Provider Demographics
NPI:1043696552
Name:DOUGLAS, ANGELA MELODY-OSKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MELODY-OSKA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:MELODY
Other - Last Name:OSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2800 W GRAND BLVD FL 5
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2610
Mailing Address - Country:US
Mailing Address - Phone:833-663-7874
Mailing Address - Fax:313-916-0874
Practice Address - Street 1:2800 W GRAND BLVD FL 5
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2610
Practice Address - Country:US
Practice Address - Phone:833-663-7874
Practice Address - Fax:313-916-0874
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010216961223G0001X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Yes1223G0001XDental ProvidersDentistGeneral Practice