Provider Demographics
NPI:1467843615
Name:ANGUS DENTISTRY
Entity Type:Organization
Organization Name:ANGUS DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-794-6893
Mailing Address - Street 1:2400 PAGEHURST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6411
Mailing Address - Country:US
Mailing Address - Phone:804-794-6893
Mailing Address - Fax:804-379-7679
Practice Address - Street 1:2400 PAGEHURST DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6411
Practice Address - Country:US
Practice Address - Phone:804-794-6893
Practice Address - Fax:804-379-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411855332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies