Provider Demographics
NPI:1730562000
Name:SHIREY, ANGELA (DMD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHIREY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:RENTSCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5621 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1442
Mailing Address - Country:US
Mailing Address - Phone:757-622-3776
Mailing Address - Fax:757-622-0146
Practice Address - Street 1:5621 TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1442
Practice Address - Country:US
Practice Address - Phone:757-622-3776
Practice Address - Fax:757-622-0146
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist