Provider Demographics
NPI:1205654704
Name:SHEDD, ANGELA D (RDH)
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:D
Last Name:SHEDD
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 1:1574 19 MILE RD
Mailing Address - Street 2:
Mailing Address - City:TEKONSHA
Mailing Address - State:MI
Mailing Address - Zip Code:49092-9203
Mailing Address - Country:US
Mailing Address - Phone:517-677-8477
Mailing Address - Fax:
Practice Address - Street 1:570 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-8252
Practice Address - Country:US
Practice Address - Phone:517-279-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902016098124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist