Provider Demographics
NPI:1225661507
Name:DIAL, ANGELICA R
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:R
Last Name:DIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 MILL RUN DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1913
Mailing Address - Country:US
Mailing Address - Phone:469-613-8936
Mailing Address - Fax:
Practice Address - Street 1:1105 MILL RUN DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-1913
Practice Address - Country:US
Practice Address - Phone:469-613-8936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula