Provider Demographics
NPI:1114584133
Name:DARGET, ANGEL (RDH)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:DARGET
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:L
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:37667 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1003
Mailing Address - Country:US
Mailing Address - Phone:313-467-6142
Mailing Address - Fax:
Practice Address - Street 1:816 JOSLYN AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2919
Practice Address - Country:US
Practice Address - Phone:248-758-1231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902014709124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist