Provider Demographics
NPI:1750016887
Name:OMUA PATRICIA ANGOLE LLC
Entity type:Organization
Organization Name:OMUA PATRICIA ANGOLE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMUA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:ANGOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-310-5034
Mailing Address - Street 1:6210 BELCREST RD APT 1031
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2972
Mailing Address - Country:US
Mailing Address - Phone:301-310-5034
Mailing Address - Fax:
Practice Address - Street 1:7501 GREENWAY CENTER DR STE 260
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3548
Practice Address - Country:US
Practice Address - Phone:240-553-7291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty