Provider Demographics
NPI:1134559446
Name:JULIAN, ANGELA MAE (RDH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAE
Last Name:JULIAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2590 SIAM RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-5367
Mailing Address - Country:US
Mailing Address - Phone:423-213-2621
Mailing Address - Fax:
Practice Address - Street 1:401 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-3588
Practice Address - Country:US
Practice Address - Phone:423-968-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6460124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist