Provider Demographics
NPI:1659023380
Name:ALBAGLE, AMENAH (DDS, MS)
Entity Type:Individual
Prefix:
First Name:AMENAH
Middle Name:
Last Name:ALBAGLE
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 N BROAD ST APT 2302
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1005
Mailing Address - Country:US
Mailing Address - Phone:267-872-5979
Mailing Address - Fax:
Practice Address - Street 1:339 N BROAD ST APT 2302
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1005
Practice Address - Country:US
Practice Address - Phone:267-872-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0434651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics