Provider Demographics
NPI:1053860627
Name:JOHNSON AND TRANG DENTAL, PC
Entity Type:Organization
Organization Name:JOHNSON AND TRANG DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:TRANG
Authorized Official - Last Name:PELACHYK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-914-5506
Mailing Address - Street 1:9321 N HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4622
Mailing Address - Country:US
Mailing Address - Phone:734-455-4070
Mailing Address - Fax:
Practice Address - Street 1:628 N GAINSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1939
Practice Address - Country:US
Practice Address - Phone:209-914-5506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010218041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty