Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3321 | AR |
NPI | 1003826314 |
---|---|
Provider Name | Bryan Keith Angel |
First Address | Little Rock, AR 72205-4747 |
Second Address | Little Rock, AR 72205-4747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145950608 | (05) | AR |