Provider Demographics
NPI:1265640825
Name:BACHTELL, ANGELA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:BACHTELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:BUNETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1931 SOUTHERN LOOP STE D
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8327
Mailing Address - Country:US
Mailing Address - Phone:318-701-8240
Mailing Address - Fax:318-670-8527
Practice Address - Street 1:1931 SOUTHERN LOOP STE D
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106
Practice Address - Country:US
Practice Address - Phone:318-701-8240
Practice Address - Fax:318-670-8527
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0186681223G0001X
LA63211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice