Provider Demographics
NPI:1083839294
Name:TANG, NANCY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 VILAMOURA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3420
Mailing Address - Country:US
Mailing Address - Phone:408-307-4263
Mailing Address - Fax:
Practice Address - Street 1:193 ARCH ST
Practice Address - Street 2:SUITE B-C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1343
Practice Address - Country:US
Practice Address - Phone:650-369-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice