Provider Demographics
NPI:1043339922
Name:CHIANG, FLORENCE LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FLORENCE
Middle Name:LEE
Last Name:CHIANG
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 1:958 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5611
Mailing Address - Country:US
Mailing Address - Phone:916-395-6805
Mailing Address - Fax:
Practice Address - Street 1:7420 GREENHAVEN DR
Practice Address - Street 2:SUITE # 120
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5161
Practice Address - Country:US
Practice Address - Phone:916-428-6618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA358611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice