Provider Demographics
NPI:1235443144
Name:GRIBBLE HEDLUND, ANGELA (DMD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GRIBBLE HEDLUND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5333
Mailing Address - Country:US
Mailing Address - Phone:678-352-1333
Mailing Address - Fax:678-352-1335
Practice Address - Street 1:2650 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5333
Practice Address - Country:US
Practice Address - Phone:678-352-1333
Practice Address - Fax:678-352-1335
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist