Provider Demographics
NPI:1013127505
Name:BRYAN KEITH ANGEL
Entity Type:Organization
Organization Name:BRYAN KEITH ANGEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-224-4799
Mailing Address - Street 1:300 S RODNEY PARHAM RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4774
Mailing Address - Country:US
Mailing Address - Phone:501-224-4799
Mailing Address - Fax:501-224-9278
Practice Address - Street 1:300 S RODNEY PARHAM RD STE 3
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4774
Practice Address - Country:US
Practice Address - Phone:501-224-4799
Practice Address - Fax:501-224-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33211223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty