Provider Demographics
NPI:1497195838
Name:HASTINGS, ANGELA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:HASTINGS
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 1:7013 CAREY LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5406
Mailing Address - Country:US
Mailing Address - Phone:763-221-5934
Mailing Address - Fax:
Practice Address - Street 1:6140 LAKE LINDEN DR
Practice Address - Street 2:SUITE 111
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2954
Practice Address - Country:US
Practice Address - Phone:952-380-1111
Practice Address - Fax:952-380-1111
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist