Provider Demographics
NPI:1093081143
Name:REBECCA ANGUS DDS AND F LEE ANGUS JR DDS PLLC
Entity Type:Organization
Organization Name:REBECCA ANGUS DDS AND F LEE ANGUS JR DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-794-6893
Mailing Address - Street 1:2400 PAGEHURST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6411
Mailing Address - Country:US
Mailing Address - Phone:804-794-6893
Mailing Address - Fax:
Practice Address - Street 1:2400 PAGEHURST DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6411
Practice Address - Country:US
Practice Address - Phone:804-794-6893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1912104753OtherINDIVIDUAL NPI