Provider Demographics
NPI:1265647549
Name:KING, ANGELA LOUISE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LOUISE
Last Name:KING
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 1:828 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1130
Mailing Address - Country:US
Mailing Address - Phone:231-598-2021
Mailing Address - Fax:
Practice Address - Street 1:1033 EAST WILCOX AVE.
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349
Practice Address - Country:US
Practice Address - Phone:231-689-6651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902012464124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist