Provider Demographics
NPI:1396435319
Name:HULL, ANGELINA CHERISE (LD)
Entity type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:CHERISE
Last Name:HULL
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 DURSTON RD STE 32
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2805
Mailing Address - Country:US
Mailing Address - Phone:406-471-2156
Mailing Address - Fax:
Practice Address - Street 1:2149 DURSTON RD STE 32
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2805
Practice Address - Country:US
Practice Address - Phone:406-640-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23732122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist