Provider Demographics
NPI:1225355662
Name:PHANG, ALLISON JEANINE (DDS)
Entity Type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:JEANINE
Last Name:PHANG
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 1:25805 SUNRISE WAY
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3845
Mailing Address - Country:US
Mailing Address - Phone:909-796-7645
Mailing Address - Fax:
Practice Address - Street 1:160 N LURING DR
Practice Address - Street 2:SUITE F
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6840
Practice Address - Country:US
Practice Address - Phone:760-325-2503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice