Provider Demographics
NPI:1730177189
Name:WIREDU, ANGELA S (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:S
Last Name:WIREDU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7861 BELLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3350
Mailing Address - Country:US
Mailing Address - Phone:301-262-2929
Mailing Address - Fax:301-262-3939
Practice Address - Street 1:7861 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3350
Practice Address - Country:US
Practice Address - Phone:301-262-2929
Practice Address - Fax:301-262-3939
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52-2039681Medicare UPIN
MD81-0896869Medicare UPIN