Provider Demographics
NPI:1659860542
Name:HARRIS, ANGELA J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:JOANNE
Other - Last Name:SVAAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:890 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7731
Mailing Address - Country:US
Mailing Address - Phone:734-474-2330
Mailing Address - Fax:
Practice Address - Street 1:890 WASHINGTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7731
Practice Address - Country:US
Practice Address - Phone:616-355-7009
Practice Address - Fax:616-355-4281
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010231991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty