Provider Demographics
NPI:1083801765
Name:NEW DENTAL IMAGES
Entity Type:Organization
Organization Name:NEW DENTAL IMAGES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VAN
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-688-1990
Mailing Address - Street 1:PO BOX 231248
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-0404
Mailing Address - Country:US
Mailing Address - Phone:916-688-1990
Mailing Address - Fax:916-688-5467
Practice Address - Street 1:6624 VALLEY HI DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-4602
Practice Address - Country:US
Practice Address - Phone:916-688-1990
Practice Address - Fax:916-688-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty