Provider Demographics
NPI:1255476453
Name:SHAM TANG AND TAM PC
Entity Type:Organization
Organization Name:SHAM TANG AND TAM PC
Other - Org Name:SMILAGE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZULLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-820-7792
Mailing Address - Street 1:72 GROVE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3241
Mailing Address - Country:US
Mailing Address - Phone:508-541-1433
Mailing Address - Fax:508-541-4131
Practice Address - Street 1:72 GROVE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-3241
Practice Address - Country:US
Practice Address - Phone:508-541-1433
Practice Address - Fax:508-541-4131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAM TANG AND TAM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-21
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110072209AMedicaid