Provider Demographics
NPI:1174296750
Name:RICHWINE, ANGELA (RDH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RICHWINE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SMYRNA ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-6041
Mailing Address - Country:US
Mailing Address - Phone:540-369-6044
Mailing Address - Fax:
Practice Address - Street 1:215 SMYRNA ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-6041
Practice Address - Country:US
Practice Address - Phone:540-369-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402202626124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist