Provider Demographics
NPI:1891950523
Name:BREEDEN, ANGELA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:BREEDEN
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 1:3695 CASCADE RD SW
Mailing Address - Street 2:STE V
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2173
Mailing Address - Country:US
Mailing Address - Phone:404-696-6595
Mailing Address - Fax:404-696-2883
Practice Address - Street 1:3695 CASCADE RD SW
Practice Address - Street 2:STE V
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2173
Practice Address - Country:US
Practice Address - Phone:404-696-6595
Practice Address - Fax:404-696-2883
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003151003AMedicaid