Provider Demographics
NPI:1184950560
Name:HAN, ANGELA S
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:S
Last Name:HAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12460 CRABAPPLE RD STE 801
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6391
Mailing Address - Country:US
Mailing Address - Phone:770-360-9131
Mailing Address - Fax:
Practice Address - Street 1:12460 CRABAPPLE RD STE 801
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6391
Practice Address - Country:US
Practice Address - Phone:770-360-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX252151223G0001X
CA583761223G0001X
GADN0160971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice