Provider Demographics
NPI:1255959920
Name:HAGEN, ANGELA MARIE WALTER (DMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE WALTER
Last Name:HAGEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1056
Mailing Address - Country:US
Mailing Address - Phone:610-406-2995
Mailing Address - Fax:
Practice Address - Street 1:2228 STATE HILL RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1904
Practice Address - Country:US
Practice Address - Phone:610-379-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427871223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist