Provider Demographics
NPI:1124409602
Name:TAN, KEE MING (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEE
Middle Name:MING
Last Name:TAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 19TH CT S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-6405
Mailing Address - Country:US
Mailing Address - Phone:205-243-0073
Mailing Address - Fax:
Practice Address - Street 1:617 19TH CT S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-6405
Practice Address - Country:US
Practice Address - Phone:205-243-0073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist