1043418676 NPI number — DR. ANGELA ROLDAN-WHITAKER D.D.S.

Table of content: DR. ANGELA ROLDAN-WHITAKER D.D.S. (NPI 1043418676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043418676 NPI number — DR. ANGELA ROLDAN-WHITAKER D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROLDAN-WHITAKER
Provider First Name:
ANGELA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043418676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5501 MARVIN SHIELDS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39501-9007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-871-2605
Provider Business Mailing Address Fax Number:
228-871-2864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAL HOSPITAL PENSACOLA
Provider Second Line Business Practice Location Address:
6000 WEST HIGHWAY 98
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32512-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-871-2605
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  55497 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 104348676 . This is a "MILITARY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".