Provider Demographics
NPI:1669608261
Name:HARRELL, ANGELA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LYNN
Last Name:HARRELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:LYNN
Other - Last Name:WOJTKOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1201 S ORTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-7600
Mailing Address - Country:US
Mailing Address - Phone:248-762-4850
Mailing Address - Fax:
Practice Address - Street 1:1201 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-7600
Practice Address - Country:US
Practice Address - Phone:248-762-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010207881223G0001X
CA57713122300000X
NY0553841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist