Provider Demographics
NPI:1043290067
Name:TANG, STANLEY CHUNGWAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:CHUNGWAI
Last Name:TANG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 FRYELANDS BLVD SE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-2944
Mailing Address - Country:US
Mailing Address - Phone:612-240-5067
Mailing Address - Fax:
Practice Address - Street 1:14711 FRYELANDS BLVD SE
Practice Address - Street 2:SUITE 111
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2944
Practice Address - Country:US
Practice Address - Phone:612-240-5067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND108541223G0001X
WADE60083251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice