Provider Demographics
NPI:1326352345
Name:CERGNUL, ANGELA N (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:N
Last Name:CERGNUL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6213 CHICAGO RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1697
Mailing Address - Country:US
Mailing Address - Phone:586-264-5410
Mailing Address - Fax:586-264-1119
Practice Address - Street 1:6213 CHICAGO RD
Practice Address - Street 2:STE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-1697
Practice Address - Country:US
Practice Address - Phone:586-264-5410
Practice Address - Fax:586-264-1119
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020279122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist