Provider Demographics
NPI:1205138252
Name:ISHAK, ANGELA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:ISHAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6940 KATY GASTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6480
Mailing Address - Country:US
Mailing Address - Phone:281-271-5100
Mailing Address - Fax:281-494-4468
Practice Address - Street 1:6940 KATY GASTON RD STE 200
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6480
Practice Address - Country:US
Practice Address - Phone:281-271-5100
Practice Address - Fax:281-494-4468
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25225122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist