Provider Demographics
NPI:1174254197
Name:TCHOUAGA, ANGE LYDIE (DDS)
Entity Type:Individual
Prefix:
First Name:ANGE LYDIE
Middle Name:
Last Name:TCHOUAGA
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 1:218 N CHARLES ST APT 2511
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4068
Mailing Address - Country:US
Mailing Address - Phone:240-338-5491
Mailing Address - Fax:
Practice Address - Street 1:2830 CAMPUS WAY N STE 614
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1669
Practice Address - Country:US
Practice Address - Phone:301-563-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist